Extracorporeal Membrane Oxygenation Candidacy Decisions: An Argument for a Process-Based Longitudinal Approach

Area of Science:

• Pediatric Critical Care
• Medical Ethics
• Cardiopulmonary Support

Background:

• Extracorporeal membrane oxygenation (ECMO) decisions are complex in pediatric critical care.
• ECMO cannulation is not universally beneficial for all critically ill children.
• Current decision-making processes may be constrained by clinical urgency.

Purpose of the Study:

• To challenge the paradigm of ECMO candidacy as a singular, pre-cannulation decision.
• To advocate for a dynamic and systematic approach to ECMO decision-making.
• To ensure ECMO decisions prioritize patient best interest regardless of cannulation status.

Main Methods:

• Conceptual analysis of ECMO decision-making paradigms.
• Advocacy for a procedural fairness model in ECMO candidacy.
• Emphasis on collaborative, interdisciplinary decision-making.

Main Results:

• The determination of ECMO benefit should be independent of cannulation status.
• A systematic, dynamic, and temporally unconstrained approach is advocated.
• Procedurally fair decision-making processes can mitigate risks of under- and over-utilization of ECMO.

Conclusions:

• ECMO decision-making requires a robust, procedurally fair process.
• Decisions should be revisited throughout the patient's management trajectory.
• This approach ensures ECMO is used judiciously, maximizing benefit and minimizing harm.