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Related Experiment Video

Updated: Mar 24, 2026

Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
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Clinician Perspectives on the Extracorporeal Membrane Oxygenation Decision-Making Process.

Derek R Soled1,2, Jacqueline M Kruser3, Alexander E Jacobs4

  • 1Department of Internal Medicine-Pediatrics, Brigham and Women's Hospital, Boston, Massachusetts.

JAMA Network Open
|March 22, 2026
PubMed
Summary

Clinician judgment, not objective guidelines, drives venovenous extracorporeal membrane oxygenation (VV ECMO) decisions for severe respiratory failure. This variability may cause inconsistent patient allocation.

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Area of Science:

  • Critical Care Medicine
  • Respiratory Medicine
  • Medical Technology

Background:

  • Venovenous extracorporeal membrane oxygenation (VV ECMO) is crucial for severe refractory respiratory failure.
  • Indications and contraindications for VV ECMO are not standardized, leading to varied clinical application.

Purpose of the Study:

  • To explore how clinicians select candidates for VV ECMO.
  • To identify criteria and their importance in VV ECMO candidacy decisions.

Main Methods:

  • Qualitative study using virtual semistructured interviews with 24 clinicians (physicians and ECMO coordinators) from 9 countries.
  • Thematic analysis of interview transcripts using inductive and deductive approaches.

Main Results:

  • Clinician interpretation of patient factors (age, BMI, ventilation time) varies.
  • Perceived contraindications are flexible, influenced by ethical and social factors.
  • Cognitive biases, institutional, and cultural contexts significantly impact VV ECMO candidacy decisions.

Conclusions:

  • VV ECMO candidacy selection relies heavily on clinical judgment rather than objective criteria.
  • Decision-making variability can result in inconsistent or inequitable patient allocation.
  • Suggestions for improving consistency in VV ECMO candidacy selection were provided.