Understanding possible ECLS indications

“The primary indication for ECLS is acute severe heart or lung failure with high mortality risk despite optimal conventional therapy. ECLS is considered at 50% mortality risk, ECLS is indicated in most circumstances at 80% mortality risk.”[1]

Acute respiratory distress syndrome (ARDS) – when the lungs drown

According to the Berlin Definition, acute respiratory distress syndrome (ARDS) is a diffuse lung injury characterized by the acute onset of impaired gas exchange within one week. ARDS is classified into three different stages: mild, moderate and severe ARDS.[2,3]

Cardiogenic shock (CS) – challenge the race against time

Cardiogenic shock (CS) is a state of reduced cardiac output leading to impaired hemodynamics and critical hypoperfusion of end organs with inadequate oxygen supply. Causes may include acute myocardial infarction with left ventricular dysfunction or arrhythmias. CS is distinct from hypovolemic shock, distributive or obstructive shock.[4]

Chronic obstructive pulmonary disease (COPD) – inflammation of the lungs that can’t be cured, but can be treated

Chronic obstructive pulmonary disease (COPD) includes several permanent, progressive respiratory diseases. The main features of COPD are permanent respiratory symptoms and airflow limitation. COPD patients often experience hypercapnia as a result of impaired gas exchange.[5]

[1] ELSO Guidelines for Cardiopulmonary Extracorporeal Life Support. Extracorporeal Life Support Organization, Version 1.4 August 2017 Ann Arbor, MI, USA

[2] Ranieri, V. M. et al. (2012). Acute respiratory distress syndrome: the Berlin Definition. JAMA, 307(23), 2526-2533

[3] Ferguson, N. D. et al. (2012). The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med, 38(10), 1573-1582

[4] Fink, M. P. et al. (2017). Textbook of Critical Care (7th edition). Mossadegh, C. & Combes, A. (2017). Elsevier

[5] Global Initiative for Chronic Obstructive Lung Disease (2022). Global Strategy for Prevention, Diagnosis and Management of COPD: 2022 Report.