Extracorporeal Life Support Organization (ELSO): 2020 Pediatric Respiratory ELSO Guideline
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Extracorporeal membrane oxygenation (ECMO) should be considered in patients in whom a reversible pathology is known or suspected, and in whom providing ECMO poses less risks than not providing extracorporeal support (Table 1).
Decisions should be made on an individual level based on knowledge of the patient’s disease, institutional experience, expert consensus, and consultation.
ECMO support should be offered in all patients with acute severe respiratory failure who demonstrate progressive persistent failure despite optimized conventional therapies and maneuvers.2
ECMO should be considered when the risk of mortality reaches 50% and is strongly indicated when mortality risk approaches 80% with conventional therapy.3 Earlier consideration may be indicated to minimize barotrauma and other morbidities from aggressive conventional therapies.
With the advent of lung protective ventilation strategies, the decision to offer ECMO may be made at an individual patient level in patients who have required 2 weeks or more of mechanical ventilation.