Which factor would NOT satisfy generally accepted ECMO eligibility criteria?

• A. Gestational age 35 weeks
• B. Oxygenation Index of 45
• C. Grade II intraventricular hemorrhage
• D. None of the above

Answer: (C)

The main idea is that neonatal ECMO eligibility hinges on balancing potential benefit with risk, particularly the risk of brain hemorrhage when anticoagulation is used during ECMO. Intraventricular hemorrhage, even if not the most severe, raises a major red flag because ECMO requires systemic anticoagulation to keep the circuit from clotting, which can worsen the bleed or lead to devastating neurologic injury. Gestational age around 35 weeks generally meets common minimums for ECMO candidacy, and an oxygenation index in the 40s indicates severe respiratory failure but is within the scenario where ECMO can be considered if other factors are favorable. Therefore, grade II intraventricular hemorrhage would not satisfy generally accepted ECMO eligibility criteria, making it the factor that disqualifies this patient.