When considering the addition of ECLS to the emergency care available at a hospital, clinicians and administrators need to be mindful of costs, in particular the opportunity costs of developing an ECPR program in lieu of other initiatives that could improve the quality of resuscitative emergency care. Human resource requirements, including staffing, emergency response teams, and ongoing education, are significant.
ECMO and ECPR shouldn’t require a radical revamping of established ethical principles or best practices. However, ethical considerations in ECMO application should be considered proactively, keeping pace with resuscitative science. The resource intensity of ECMO care, the complexity of bridge-to-nowhere cases, and the uncertain role of ECMO in end-of-life conversations should serve as ethical limits to unconstrained growth of this technology, making sure the tail of technology isn’t wagging the dog of ethical practice.
Dr. Allen is director of healthcare ethics, Billings Clinic, Billings, Montana; and adjunct assistant professor of Medicine and Medical Ethics, Baylor College of Medicine, Houston, Texas.
Dr. Jesus is an attending physician, Augusta Medical Center, Fishersville, Virginia.
Dr. Knowles is director of leadership and advocacy for Integrative Emergency Services; and core faculty at John Peter Smith Health Network, Fort Worth, Texas.
Dr. Larkin is a professor at the University of Auckland/New York University.
Dr. Schears transitioned from the Mayo Clinic, is currently studying social justice and micro-economics at the Heller School in the inaugural year of the executive MBA program for physicians at Brandeis University.
References
- Brooks SC, Anderson ML, Bruder E, et al. Part 6: alternative techniques and ancillary devices for cardiopulmonary resuscitation: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18 suppl2):S436-S443.
- Johnson NJ, Acker M, Hsu CH, et al. Extracorporeal life support as rescue strategy for out-of-hospital and emergency department cardiac arrest. Resuscitation. 2014;85(11):1527-1532.
- Bellezzo JM, Shinar Z, David DP, et al. Emergency physician-initiated extracorporeal cardiopulmonary resuscitation. Resuscitation. 2012;83(3):966-970.
- Sakamoto T, Morimura N, Nagao K, et al. Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: a prospective observational study. Resuscitation. 2014;85(6):762-768.
- Maekawa K, Tanno K, Hase M, et al. Extracorporeal cardiopulmonary resuscitation for patients with out-of-hospital cardiac arrest of cardiac origin: a propensity-matched study and predictor analysis. Crit Care Med. 2013;41(5):1186–1196.
- Avalli L, Maggioni E, Formica F, et al. Favourable survival of in-hospital compared to out-of-hospital refractory cardiac arrest patients treated with extracorporeal membrane oxygenation: an Italian tertiary care centre experience. Resuscitation. 2012;83(5):579-583.
- Riggs KR, Becker LB, Sugarman J. Ethics in the use of extracorporeal cardiopulmonary resuscitation in adults. Resuscitation. 2015;91:73-75.
- Ramanathan K, Cove ME, Caleb MG, et al. Ethical dilemmas of adult ECMO: emerging conceptual challenges. J Cardiothorac Vasc Anesth. 2015;29(1):229-233.
- American College of Emergency Physicians. Code of ethics for emergency physicians. Ann Emerg Med. 2008;52(5):581-590.
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