Reported Practices in End-of-Life Decision-Making During Extracorporeal Life Support (ENSURE)-Results From an International European Chapter of the Extracorporeal Life Support Organization Survey.

Abstract

The ENd-of-life deciSion-making dURing Extracorporeal life support (ENSURE) survey aimed to assess current clinical practices and perspectives on end-of-life decisions for patients on extracorporeal life support (ECLS) across Europe. Understanding the challenges surrounding ECLS withdrawal may help mitigate moral distress in this complex decision-making process. The survey covered 20 questions to be assessed online and was composed of two sections: the first dealt with general questions on hospital details, ICU profile, ECLS provision, and participants' profession, and the second part was designed to elicit clinical questions, institutional protocols, management, and palliative care provision. For most of the questions, multiple-choice answers were provided. The survey was translated into 31 native European languages and captured respondents' actual practices, institutional protocols, management approaches, and palliative care provision related to ECLS discontinuation. Critically ill patients on ECLS when treatment goals are no longer achievable. None. Responses from 570 participants across 28 European countries showed that physicians (99%), nurses (63%), and relatives (54%) are commonly involved in ECLS end-of-life discussions. Although 49% of institutions offer clinical ethics committee access and 12% provide clinical ethicists, 24% lack any ethics support for challenging decisions. When ECLS goals fail, 41% of respondents reported discontinuing ECLS with comfort care, with Northern and Western Europeans most likely to report this practice (54% and 59%). Southern and Eastern Europeans more often reported limiting life-sustaining treatments without stopping ECLS (42% and 46%). Differences could also be observed for professionals with different religious backgrounds. The ENSURE survey highlights significant regional and cultural variations in reported ECLS discontinuation practices across Europe, likely influenced by clinicians' diverse backgrounds and institutional contexts. These differences, alongside limited ethics and palliative care support, underscore the need for structured interventions to enhance consistency and reduce moral distress in end-of-life decision-making for ECLS patients.