Contraindication screening for ECMO consultation
ECMO Contraindications Checklist for referral discussions
Screen major and relative contraindication concerns before ECMO referral discussions, including neurologic injury, bleeding, anticoagulation limitations, prolonged injurious ventilation, frailty, and multiorgan failure.
This tool supports referral discussion only. It does not determine ECMO candidacy. Final decisions require the receiving ECMO center and local protocol.
Step 01
ECMO contraindication screen
Mark each concern as no concern, relative concern, or major concern. Use this to structure referral discussion, not to accept or reject ECMO.
No Concern
10
Relative
0
Major
0
Irreversible disease / non-recoverable condition
Underlying disease process is unlikely to recover or bridge to a meaningful destination despite extracorporeal support.
No contraindication concern selected for this item.
Severe neurologic injury
Known or suspected devastating neurologic injury, poor neurologic prognosis, or inability to meaningfully assess neurologic status.
No contraindication concern selected for this item.
Active uncontrolled bleeding
Bleeding that may worsen with cannulation, circuit anticoagulation, platelet dysfunction, or ECMO-associated coagulopathy.
No contraindication concern selected for this item.
Contraindication to anticoagulation
Severe bleeding risk, recent hemorrhage, intracranial bleeding concern, or other reason anticoagulation may be unsafe.
No contraindication concern selected for this item.
Prolonged high-pressure mechanical ventilation
Extended exposure to injurious ventilator pressures before referral may reduce expected benefit from VV ECMO.
No contraindication concern selected for this item.
Severe frailty / advanced physiologic age
Frailty, poor baseline functional status, or physiologic reserve may limit recovery even when chronological age alone is not absolute.
No contraindication concern selected for this item.
Severe multiorgan failure
Progressive shock, severe renal/hepatic failure, refractory acidosis, or multiple failing systems may alter ECMO risk-benefit.
No contraindication concern selected for this item.
Profound immunosuppression
Severe immunosuppression, uncontrolled malignancy, or profound host-factor risk may affect candidacy depending on center protocol.
No contraindication concern selected for this item.
Goals-of-care concern
Patient goals, surrogate understanding, code status, or acceptable outcomes are unclear or may not align with ECMO burden.
No contraindication concern selected for this item.
Other center-specific limitation
Local ECMO program criteria, transfer feasibility, cannulation constraints, resource limitations, or diagnosis-specific concerns.
No contraindication concern selected for this item.
What are ECMO contraindications?
ECMO contraindications are clinical factors that may reduce expected benefit, increase procedural risk, complicate anticoagulation, or make recovery unlikely. They are best treated as discussion points with an ECMO center rather than isolated yes-or-no rules.
Absolute vs relative contraindications
Some concerns may be major in one clinical context and relative in another. Bleeding risk, age, frailty, neurologic status, and multiorgan failure often require center-specific interpretation and multidisciplinary review.
Why contraindications differ between ECMO centers
ECMO programs vary in case volume, cannulation capability, transplant pathways, anticoagulation strategy, specialty support, transport resources, and local protocols. Early consultation helps clarify whether a concern is modifiable, relative, or prohibitive for that center.
Why prolonged injurious ventilation matters
Longer exposure to high plateau pressure, high driving pressure, severe ventilator-induced lung injury risk, or prolonged pre-referral ventilation may reduce the likelihood of benefit from VV ECMO. This is why early referral discussion matters in severe ARDS.