Commentary and conceptsEthics in the use of extracorporeal cardiopulmonary resuscitation in adults☆
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)
- et al.
Back from irreversibility: extracorporeal life support for prolonged cardiac arrest
Ann Thorac Surg
(2005) - et al.
Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: a prospective observational study
Resuscitation
(2014) - et al.
Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis
Lancet
(2008) - et al.
European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary
Resuscitation
(2010) - et al.
Ethical dilemmas encountered with the use of extracorporeal membrane oxygenation in adults
Chest
(2014) - et al.
Temporal patterns in long-term survival after resuscitation from out-of-hospital cardiac arrest
Circulation
(2003) - et al.
Trends in survival after in-hospital cardiac arrest
N Engl J Med
(2012) - et al.
Extracorporeal life support organization registry report 2012
ASAIO J
(2013) - 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)
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2021, ResuscitationCitation 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 SurgeryCitation 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, ResuscitationCitation 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.
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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.