The Human Impact of ECMO: Best Practices to Improve Experiences of Patients, Families, and Clinicians.

Abstract

As extracorporeal membrane oxygenation (ECMO) utilization has increased and evolved over decades, much literature has focused on the technical and clinical aspects, with substantially less attention paid to the impact of ECMO support on patients, families, and clinicians. As part of the ECMO Ethics Workgroup project, this paper explores the experiential aspects and impacts of ECMO on clinicians, patients, and families. Review of available literature identifies substantial physical and psychological burdens associated with ECMO survivorship as well as psychosocial challenges for family members and medical decision makers. We also examine the impact of ECMO support on clinicians providing care. Though many challenging experiences associated with ECMO are potentially unavoidable consequences of care, we recognize an ethical imperative to improve our understanding of such challenging experiences and develop strategies to reduce or resolve them. As such, we review the current literature and provide recommendations based on our current understanding to improve the experiences of those impacted by ECMO. Our recommendations include guidance on clear and consistent decision-making frameworks, interdisciplinary communication, incorporation of patient values, and early ethics and palliative care consultation. Given the limited evidence, we also call for further research to support best practices in ECMO care, particularly regarding interdisciplinary communication, expert consultation, educational interventions for families, and systematic follow-up of survivors.