TABLE 1

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

Justified and strongly recommendedPerhaps indicated under individual conditionsNo indication (high probability)
Age <60 yearsAge 60–69 yearsAge >70 years
Good to moderate prognosis on acceptable quality of lifeUncertain prognosis on acceptable quality of lifeUnacceptable 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 daysOnset of severe ARDS 4–7 daysOnset of severe ARDS >7 days with concomitant signs of fibrosis of the lung
No considerable comorbidities, good general health statusModerate 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: proPatient's will unclear, next of kin undecidedA declared or presumed patient's will: contra
No chronic illness with expectancy of life shorteningChronic illness with uncertainty of life shorteningChronic illness with clear reduction of life expectancy

For the graded indication all aspects of the column should be fulfilled.