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Table 4
EACTS, ELSO, STS, and AATS joint recommendations for indications, contraindications, and prognostication of PC-ECLS [4].
| Recommendations | Class of recommendation | Level of evidence |
|---|---|---|
| Lactate level < 4 mmol/L in patients likely to have myocardial recovery and in the absence of uncontrollable bleeding, not amenable to surgical repair | I | B |
| If likelihood of myocardial recovery is low, PC ECMO is recommended in patients eligible for LVAD or heart transplant | I | C |
| Early use of PC ECMO in an IABP patient and optimal medical therapy, with failure to wean from CPB or marginal hemodynamics, is recommended | I | B |
| Significant comorbidities, advanced age, elevated lactate level, and renal injury are risk factors for death and should be considered pre-ECMO | IIa | B |
| Preoperative implant of ECLS may be considered in patients in poor hemodynamic or metabolic condition or with structural cardiac anomalies (post-acute MI, VSD, severe lung edema or dysfunction due to underlying cardiac disease), to facilitate perioperative management (bridge to surgery). | IIb | C |
| The type of ECLS discussed should be based on hemodynamic conditions and patient characteristics | IIa | C |
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