Ethical dilemmas of adult ECMO: emerging conceptual challenges.

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) is an invaluable rescue therapy for patients with refractory respiratory or cardiac failure. Recent developments in cardiopulmonary bypass technology, such as miniaturized extracorporeal devices, heparin-coated circuits, and percutaneous cannulation techniques, have facilitated widespread application of ECMO in different clinical situations. 1 Grasselli G. Pesenti A. Marcolin R. et al. Percutaneous vascular cannulation for extracorporeal life support (ECLS): a modified technique. Int J Artif Organs. 2010; 33: 553-557 PubMed Google Scholar The decision to initiate ECMO is made more difficult by uncertainties surrounding who might most benefit from it. These apprehensions are compounded by the practical indications for ECMO changing over time. Potential conflicts occur when the next of kin or the patient’s proxies and physician do not agree on treatment options, when options are scarce or unavailable, and when the options themselves are unclear because of uncertainties about the effectiveness or the duration of treatment. 2 Gamulka B.D. Ethical uncertainty: an approach to decisions involving extracorporeal membrane oxygenation. CMAJ. 1994; 150: 565-568 PubMed Google Scholar