Ethics in prehospital extracorporeal cardiopulmonary resuscitation

Prehospital extracorporeal cardiopulmonary resuscitation (ECPR) shows potential in improving outcomes in out-of-hospital cardiac arrest (OHCA) with emerging adoption in multiple systems internationally. Ethical implications differ between hospital-based and prehospital ECPR systems as the prehospital environment introduces unique considerations related to location, timing, consent, patient selection, triage, and patient access. Prehospital ECPR may have unique benefits in avoiding ethical pitfalls of in-hospital cannulation. Ethical considerations specific to prehospital ECPR should be assessed prior to implementation with thorough risk-benefit analysis utilizing fundamental ethical principles from the perspectives of affected stakeholders.