ECMO during the COVID-19 pandemic: moving from rescue therapy to more reasonable indications

TABLE 1

A gradual assessment of indications for implementation of extracorporeal membrane oxygenation in critical acute respiratory distress syndrome (ARDS)

Justified and strongly recommended	Perhaps indicated under individual conditions	No indication (high probability)
Age <60 years	Age 60–69 years	Age >70 years
Good to moderate prognosis on acceptable quality of life	Uncertain prognosis on acceptable quality of life	Unacceptable quality of life probable (e.g. continuous dependency on organ replacement therapies, artificial ventilation, haemodynamic support and/or chronic immobility)
No additional organ failure (except lung)	Mild additional organ insufficiency (except lung)	Additional multi-organ failure with low probability of recovery (except lung)
Onset of severe ARDS <3 days	Onset of severe ARDS 4–7 days	Onset of severe ARDS >7 days with concomitant signs of fibrosis of the lung
No considerable comorbidities, good general health status	Moderate comorbidities without necessity for organ replacement (e.g. dialysis)	Severe comorbidities requiring continuous support (e.g. dialysis, inotropes), high frailty, poor general health status
A declared or presumed patient's will: pro	Patient's will unclear, next of kin undecided	A declared or presumed patient's will: contra
No chronic illness with expectancy of life shortening	Chronic illness with uncertainty of life shortening	Chronic illness with clear reduction of life expectancy