Anaesthesia / Critical Care Respiratory Strong — standard ECMO referral criterion; endorsed by ELSO guidelines

Murray Score for Acute Lung Injury (ALI/ARDS)

Quantifies severity of acute lung injury / ARDS using 4 parameters. Also used to define criteria for ECMO referral (Murray score ≥ 3 despite optimal ventilation).

Score interpretation

No Lung Injury 0

Murray Score 0: No acute lung injury.

→ No specific intervention. Treat underlying cause. Lung-protective ventilation if intubated.

Mild-Moderate Lung Injury 0.1–2.4

Murray Score 0.1–2.4: Mild to moderate ALI.

→ Lung-protective ventilation (TV 6 mL/kg IBW, PEEP titration). Treat underlying cause. Daily SOFA. Prone if P/F < 150 not improving.

Severe ARDS — Consider ECMO Referral 2.5–3

Murray Score 2.5–3.0: Severe lung injury. ECMO may be indicated.

→ Refer to ECMO centre if Murray ≥ 3 despite optimal ventilation (6 mL/kg, FiO₂ > 0.9, PEEP ≥ 10, prone positioning). Neuromuscular blockade. Recruitment manoeuvres per local protocol.

Severe ARDS — ECMO Indicated 3.1–4

Murray Score > 3: Severe ARDS. ECMO strongly indicated if no contraindications.

→ Urgent ECMO referral. Maintain 'ultra-lung-protective' ventilation (TV 4–6 mL/kg, low PEEP, low FiO₂) while awaiting ECMO. Involve senior intensivist.

Interpretation bands for the Murray Score. Apply clinical judgement and local guidance.

References

Murray JF, et al. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis. 1988;138(3):720–723.
Peek GJ, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374(9698):1351–1363.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

Related