ECMO Ethics: A Call for Action.

Abstract

Extracorporeal membrane oxygenation (ECMO) is a relatively novel, intensive medical intervention. It is known to raise important yet unsettled ethical concerns. We established the ECMO Ethics Workgroup in 2021 to improve our understanding of these ethical issues and their possible resolutions. This paper explains the methods used to produce our insights and recommendations, which additional papers from the project elaborate upon in detail. Initially, over six months, the 37 group members described the full range of ethical issues in ECMO care they were familiar with from experience, interpretation of relevant scholarship, and in response to our discussions. After we identified five major ethical themes and several sub-themes for analysis, the group restructured into smaller writing groups. Each group performed narrative and meta-narrative reviews targeting the themes of experiencing ECMO, starting ECMO, stopping ECMO, specialist consultants involved in ECMO care, and "other" themes. In addition to summarizing our insights and recommendations regarding four of these themes, this paper recommends revising the common conceptualization of ECMO therapy in terms of "bridges." To improve communication about ECMO care, we propose three categories of ECMO bridges, therapeutic, potentially therapeutic, and non-therapeutic, including the idea of "bridge to palliative care" in lieu of the concept of "bridge to nowhere."