UR Medicine Acute Shock Program
Patient Referral Guidelines
Lung Rescue
Lung Rescue Team Coordination
Lung Rescue Team Goals
- Early identification and coordinated care.
- Early support with VV ECMO.
- Complete lung recovery and improved survival.
STEP 1: INCLUSION CRITERIA
Acute respiratory failure failing conventional medical management. Examples including ARDS, status asthmaticus and/or air leak syndromes.
(A) Clinical Criteria
- PaO2/FiO2 ratio < 80 x6h
- PaO2/FiO2 ratio < 50 x3h
- pH < 7.25 and/or pCO2 > 60 x6h
- High pressure, high oxygen mechanical ventilator settings
STEP 2: REVIEW
Relative Exclusion Criteria for MCS:
- Age > 65
- Neurologic injury
- Severe MOSF
- Bleeding
- Prohibitive vascular access
- DNR
If criteria for severe respiratory failure are met:
Shock team alert with CICU/Cardiac surgery review and discussion.
Shock team alert with CICU/Cardiac surgery review and discussion.
- Continuation of medical optimization including treating modifiable conditions such as volume overload, atelectasis and/or pneumothorax.
- Attempt prone positioning when appropriate.
- Trial of neuromuscular blocking agents and/or inhaled pulmonary vasodilators.
STEP 3: ACTIVATE
Shock team activation with virtual discussion before MCS and primary versus secondary ECMO transport;
we offer a mobile respiratory ECMO team.
Admit to CICU for advanced respiratory support.