Ethical Considerations for Mechanical Support

Extracorporeal life support (ECLS) has the ability to support patients with severe forms of cardiac and respiratory failure. Rapid expansion of ECLS, its resource-intensive and invasive nature, and the high acuity illness of supported patients have raised important questions. Specific issues include identification of patients most likely to benefit, the appropriate duration of support amid uncertain prognosis, and what to do when patients become dependent on ECLS 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 ECLS in advanced cardiopulmonary failure.