Ethical Considerations for Mechanical Support

Darryl Abrams; J Randall Curtis; Kenneth M Prager; A Reshad Garan; Jonathan Hastie; Daniel Brodie

doi:10.1016/j.anclin.2019.08.001

Ethical Considerations for Mechanical Support

Anesthesiol Clin. 2019 Dec;37(4):661-673. doi: 10.1016/j.anclin.2019.08.001. Epub 2019 Oct 11.

Authors

Darryl Abrams¹, J Randall Curtis², Kenneth M Prager³, A Reshad Garan⁴, Jonathan Hastie⁵, Daniel Brodie⁶

Affiliations

¹ Division of Pulmonary, Allergy, and Critical Care, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH 8E, 101, New York, NY 10032, USA. Electronic address: da2256@cumc.columbia.edu.
² Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359762, Seattle, WA 98104, USA.
³ Division of Pulmonary, Allergy, and Critical Care, Columbia University College of Physicians and Surgeons, 161 Ft. Washington Avenue, Room 307, New York, NY 10032, USA.
⁴ Division of Cardiology, Columbia University College of Physicians and Surgeons, 177 Ft. Washington Avenue, 5th Floor, Room 5-435, New York, NY 10032, USA.
⁵ Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH 5-505, New York, NY 10032, USA.
⁶ Division of Pulmonary, Allergy, and Critical Care, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH 8E, 101, New York, NY 10032, USA.

PMID: 31677684
DOI: 10.1016/j.anclin.2019.08.001

Abstract

Extracorporeal life support can support patients with severe forms of cardiac and respiratory failure. Uncertainty remains about its optimal use owing in large part to its resource-intensive nature and the high acuity illness in supported patients. Specific issues include the identification of patients most likely to benefit, the appropriate duration of support when prognosis is uncertain, and what to do when patients become dependent on extracorporeal life support but no longer have hope for recovery or transplantation. Careful deliberation of ethical principles and potential dilemmas should be made when considering the use of extracorporeal life support in advanced cardiopulmonary failure.

Keywords: Bridge to nowhere; ECMO; Ethics; Extracorporeal life support; Withdrawal of life support.

Publication types

Review

MeSH terms

Advanced Cardiac Life Support / ethics*
Cardiac Surgical Procedures / ethics*
Cardiac Surgical Procedures / methods
Extracorporeal Membrane Oxygenation / ethics
Humans
Perioperative Care / ethics*
Perioperative Care / methods