Ethical Considerations in Relation to Extracorporeal Membrane Oxygenation

Ethical Considerations in Relation to Extracorporeal Membrane Oxygenation

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As medical technology continues to advance, options to treat what were once thought to be fatal conditions continue to increase. Extracorporeal membrane oxygenation (ECMO) has been used since the 1970s and became a common therapy for newborns with respiratory failure (Rehder, Turner, & Cheifetz, 2011). Despite ECMO’s proven pediatric use, there are still ethical concerns over this therapy. There are concerns over the expense of this particular therapy in relation to results (Richards & Joubert, 2013). There are also multiple complications that can occur while using ECMO, and recently the expansion of using ECMO in adults with acute respiratory distress syndrome (ARDS), using ECMO as a bridging therapy while awaiting organ transplantation, and also using ECMO to maintain organ perfusion in organ donation have all brought up ethical considerations. Research is ongoing to further explore these issues.
The Basics of ECMO
ECMO is an external cardiopulmonary bypass circuit that serves to temporarily replace the functions of the heart and lungs. This necessitates the surgical placement of a catheter into a central vein located near the heart and a second catheter that can be placed in either a different central vein (VV ECMO), which is used for respiratory support, or placed into artery (VA ECMO), used when the patient requires cardiac and respiratory support. These catheters are connected to the ECMO machine where the blood is pumped through an oxygenator where carbon dioxide is removed and oxygen instilled (
ECMO has an established history of being used as a pediatric modality with critically ill patients as a last life-saving effort. Yet, there still is controv...

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...dult Respiratory Failure: Life Support in the New Era. Intensive Care Med, 38, 210-220.
Mishra, V., Svennevig, J. L., Bugge, J. F., Andresen, S., Mathisen, A., Karlsen, H., ... Hagen, T. P. (2009, August 21, 2009). Cost of Extracorporeal Membrane Oxygenation: Evidence From the Rikshospitalet University Hospital, Oslo, Norway. European Journal of Cardiothoracic Surgery, 37, 339-342.
Rehder, K. J., Turner, D. A., & Cheifetz, I. M. (2011). Use of Extracorporeal Life Support in Adults with Severe Acute Respiratory Failure. Expert Rev. Respir. Med., 5(5), 627-633.
Richards, G. A., & Joubert, I. (2013, July 2013). Extracorporeal Membrane Oxygenation (ECMO). South African Journal of Critical Care, 29(1), 7-9.

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