Clinician Perspectives on the Extracorporeal Membrane Oxygenation Decision-Making Process

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.