VV ECMO referral decision support
VV ECMO Referral Criteria for severe ARDS
Screen severe ARDS patients for common VV ECMO referral triggers using P/F ratio, respiratory acidosis, ventilator intensity, rescue therapy status, and major contraindication cautions.
Use this workflow with the P/F Ratio calculator, Oxygenation Index calculator, ARDSNet calculator, and ABG Analyzer when deciding whether to call an ECMO center.
Step 01
Gas exchange and ventilator intensity
Enter the values that define severe hypoxemic or hypercapnic respiratory failure.
Current P/F
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Step 02
Rescue therapy status
Mark whether high-value ARDS rescue strategies have been attempted, are contraindicated, or are still unknown.
Prone positioning attempted or contraindicated
Severe ARDS patients often warrant prone positioning before ECMO when feasible.
Neuromuscular blockade / deep synchrony strategy considered
Use when ventilator dyssynchrony, high drive, or injurious ventilation is contributing.
Step 03
Major caution flags
Select factors that may limit ECMO candidacy or require specialist discussion before transfer.
How to use this VV ECMO referral tool
This tool is designed for early bedside escalation conversations in severe ARDS. It highlights severe hypoxemia, refractory hypercapnic acidosis, high ventilator intensity, incomplete rescue therapy, and major caution flags.
A positive referral trigger does not mean the patient automatically receives ECMO. It means the case may deserve timely discussion with an ECMO-capable center before prolonged injurious ventilation reduces candidacy.
Clinical caution
ECMO candidacy depends on reversibility, severity of non-pulmonary organ failure, neurologic prognosis, bleeding risk, duration of mechanical ventilation, frailty, local criteria, and goals of care.
Do not delay urgent specialist consultation when gas exchange is failing despite lung-protective ventilation, prone positioning, paralysis/synchrony strategies, and high-level ICU support.