Elsevier

Resuscitation

Volume 91, June 2015, Pages 73-75
Resuscitation

Commentary and concepts
Ethics in the use of extracorporeal cardiopulmonary resuscitation in adults

https://doi.org/10.1016/j.resuscitation.2015.03.021Get rights and content

Abstract

Extracorporeal cardiopulmonary resuscitation (ECPR) promises to be an important advance in the treatment of cardiac arrest. However, ECPR involves ethical challenges that should be addressed as it diffuses into practice. Benefits and risks are uncertain, so the evidence base needs to be further developed, at least through outcomes registries and potentially with randomized trials. To inform decision making, patients’ preferences regarding ECPR should be obtained, both from the general population and from inpatients at risk for cardiac arrest. Fair and transparent appropriate use criteria should be developed and could be informed by economic analyses.

Section snippets

Benefits and risks

Current information on the clinical benefits and harms of ECPR comes from observational studies; data from randomized controlled trials are not available. If there were no potential clinical downsides to providing ECPR, moderate quality evidence suggesting benefit might be sufficient to justify providing it to patients who otherwise face a grave prognosis. However, ECPR is associated with potential harms. For example, in one study ECPR was associated with higher survival with good neurologic

Towards addressing the ethical challenges

Given the ethical challenges in the provision of ECPR, there are important steps that policy makers, hospital administrators, professional groups, researchers, and clinicians can take to ensure that this potentially life-saving technology is provided responsibly.

As an emerging technology with unproven benefit and the potential for serious harm, stakeholders should commit to continuing to develop the evidence base for ECPR. In addition to focusing on short-term mortality, evidence is needed

Conflict of interest statement

Dr. Riggs has no potential conflicts of interest to declare. Dr. Sugarman serves as the Ethics Officer for the NIH Resuscitation Outcomes Consortium. Dr. Becker serves on the Data Safety Monitoring Committee and Protocol Review Committee of the NIH Resuscitation Outcomes Consortium.

Acknowledgments

Dr. Riggs's work on this manuscript was supported by NIH Grant T32HL007180 and a Hecht-Levi post-doctoral fellowship in bioethics. The funding sources had no role in the design and conduct of the study, analysis or interpretation of the data, and preparation or final approval of the manuscript prior to publication.

References (19)

There are more references available in the full text version of this article.

Cited by (57)

  • ECMO for cardiopulmonary arrest (ECPR)

    2022, Cardiopulmonary Bypass: Advances in Extracorporeal Life Support
  • Ethics of ECPR research

    2021, Resuscitation
    Citation Excerpt :

    It could also be an extra emotional burden for relatives, providing false hopes or futile intervention. While it does provide time to bid farewell, temporarily averting death burdens the family with several days of continued uncertainty and, in some instances, by having to ‘turn off’ the life support.19 Can such a high-risk study intervention be justified in a clinical trial?

  • The Ethics of Extracorporeal Membrane Oxygenation: Revisiting the Principles of Clinical Bioethics

    2021, Annals of Thoracic Surgery
    Citation Excerpt :

    In addition, it may help families by eliminating the burden of guilt associated with making a very tough decision about whether or not to continue ECMO treatment. At the same time, however, one can be faced with the difficult situation whereby a now lucid patient on ECMO refuses to have it removed even in the setting of no reasonable therapeutic options for their underlying pathology and thus has now entered a “bridge to nowhere” phenomenon.6,23,24 The concept of benefitting the patient is a central responsibility of the clinician.

  • Extracorporeal cardiopulmonary resuscitation for acute aortic dissection during cardiac arrest: A nationwide retrospective observational study

    2020, Resuscitation
    Citation Excerpt :

    In contrast, other researchers suggest that AAD should not be considered a contraindication for ECPR because there is a good chance of successfully returning patients to society. In addition, the ethical considerations regarding the use of ECPR are complex,31 and further discussion and studies are needed. The present study has limitations.

View all citing articles on Scopus

A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2015.03.021.

View full text