Chest
Medical EthicsEthical Dilemmas Encountered With the Use of Extracorporeal Membrane Oxygenation in Adults
Section snippets
Limiting ECMO Support
The vignettes in this article illustrate the goal of ECMO to bridge patients either to recovery or transplant. However, they also highlight the inherent limitations of device-based therapies. When ECMO is no longer meeting its intended goals, a discussion of limiting treatment to either no escalation of life support or withdrawal of life support should be considered. Although the amount of ECMO support may be easily adjusted at the bedside, increases in ECMO blood flow, CO2 removal, or oxygen
Conclusions
As the use of ECMO continues to grow, clinicians will increasingly confront complex and sensitive ethical issues. It is important that the wisdom with which ECMO is used keep pace with advances in its use. For patients and their surrogates to be adequately prepared to make informed medical decisions, it is the physician's responsibility to disclose not only the possibilities but also the limitations of these medical technologies. Our obligation to respect the autonomy of the patient and work
Acknowledgments
Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Other contributions: We thank Baruch Brody, PhD, Baylor College of Medicine; Mark Siegler, MD, MacLean Center for Clinical Medical Ethics at the University of Chicago; and Art Caplan, PhD, New York University, for their invaluable contributions to this discussion.
Additional information:
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