3rd BEACH Course - Session 1

3rd BEACH Course - Session 1

Indications and contraindications (S Bouchez)

The origins of ECMO, the story of the Lindberg pump - link

Indications for ECMO

  • No absolute inidications
  • Institute specific
  • Multiple studies with variable outcomes

Advantages of ECMO

  • Immediate improvement of hemodynamics
  • Oxygenation & metabolic restauration
  • Technical not difficult (relative)
  • Bedside
  • Compared to other options : $


  • Respiratory failure --> VV ECMO
  • Circulatory failure --> VA ECMO


  1. 80% mortality risk 
    • PaO2/FiO2 < 100 on FiO2> 90%
    • +/- Murray score 3-4, AOI >80, APSS 8
    • despite optimal care for 6 hours or less
  2. CO2 retention
    • despite high Pplat (> 30mmHg)
  3. Other
    • Severe air leak syndromes
    • Respiratory collapse ( blocked airways…)
    • Surgery (trachea…)

Screenshot 2019 10 11 at 20.58.39



  1. Cardiogenic shock
    • Acute coronary syndrome
    • Myocarditis
    • Pulmonary embolism
    • Post-cardiotomy
  2. Periprocedural support
    • PCI
    • Surgery
  3. Sepsis (in some centers)

Screenshot 2019 10 11 at 21.01.34

Mechanical Circulatory Support Devices for Cardiogenic Shock: State of the Art

Management of cardiogenic shock complicating myocardial infarction: an update 2019


Selection of the right patient at the right time

When to start and stop ECMO

Avoid Bridge to nowhere


ECMO Principles and Different Modes

VV-ECMO functions as an artificial lung working in addition to the patient's own failing lungs

  • To maintain gas exchanges
  • To allow protective ventilation
  • To allow “lung rest”
  • To allow “lung recovery”
  • To gain time for LTx

Picture 1

Screenshot 2019 10 11 at 21.08.38

Cardiac ECMO 

Multiple configurations - The ELSO Maastricht Treaty for ECLS Nomenclature: abbreviations for cannulation configuration in extracorporeal life support - a position paper of the Extracorporeal Life Support Organization

Picture 2

Picture 3

Anticoagulation and ECMO

Anticoagulation Practices during Venovenous Extracorporeal Membrane Oxygenation for Respiratory Failure. A Systematic Review.

Anticoagulation practices and the prevalence of major bleeding, thromboembolic events, and mortality in venoarterial extracorporeal membrane oxygenation: A systematic review and meta-analysis.

Monitoring coagulation on ECMO

  • Combination of ACT, aPTT, anti Xa with
    • ATIII
    • Platelet count / function
    • Fibrinogen
    • Viscoelastic test (How fast- how strong- for how long?)

NO SINGLE TEST may be considered adequate to guide (UFH) management


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