INTRODUCTION
Extracorporeal membrane oxygenation (ECMO) is a validated technique for the temporary treatment of circulatory and/or respiratory failure(1). Although the indications are well defined(2), contraindications are not as clear and should be assessed on a patient-specific reasoning based on the clinical presentation. Apart from the obvious and irreversible multi-organ failure, the decision to not implement Veno-Arterial ECMO (VA-ECMO) is the result of a multi-disciplinary assessment between health professionals including the heart surgeon and the intensivist physician. Moreover, the decision-making process has to be extremely quick considering the high instability of such critically ill patients.
Acidosis with a blood pH<7 is in real life recognized by most physicians as a contraindication to VA-ECMO placement, but without strong evidence to support this statement. In the SAVE score, serum bicarbonate level (≤15 mmol/L) was identified as a poor prognostic factor(3), but without any mention to blood pH specifically. We previously explored that pH<7 appeared to be a poor prognostic factor but at that time we had much less patients in our series (1). Data in the literature of VA-ECMO using these simple biological parameters to play a role in the decision-making process are scarce (4,5).
We sought to investigate the proportion of patients implanted with low pH to compare the survival between groups according to pH levels at cannulation in our VA-ECMO cohort.