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Updated: Aug 6, 2026
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Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
Published on: January 17, 2025
ECMO Ethics: A Call for Action
Thomas V Cunningham1, Joyeeta Dastidar2, Anna Condella3
1Kaiser Permanente Southern California Bioethics Program, West Los Angeles Medical Center, 6041 Cadillac Ave, Los Angeles, CA 90034.
Chest
|July 17, 2026
Summary
Extracorporeal membrane oxygenation (ECMO) presents complex ethical challenges. This workgroup proposes a new framework for ECMO "bridges" to improve communication and ethical care.
Area of Science:
- Medical Ethics
- Intensive Care Medicine
Background:
- Extracorporeal membrane oxygenation (ECMO) is an intensive medical intervention with significant ethical considerations.
- An ECMO Ethics Workgroup was formed in 2021 to address these complex ethical issues.
Purpose of the Study:
- To detail the methods used by the ECMO Ethics Workgroup to generate insights and recommendations.
- To propose a revised conceptualization of ECMO therapy using a framework of "bridges" to enhance communication.
Main Methods:
- A 37-member workgroup identified and analyzed ethical themes in ECMO care over six months.
- Utilized narrative and meta-narrative reviews focusing on experiencing, starting, and stopping ECMO, and specialist consultant roles.
- Synthesized insights and recommendations from four major ethical themes.
Main Results:
- Identified five major ethical themes and several sub-themes within ECMO care.
- Developed recommendations for addressing ethical issues in ECMO.
- Proposed three categories of ECMO bridges: therapeutic, potentially therapeutic, and non-therapeutic.
Conclusions:
- Revising the conceptualization of ECMO therapy as "bridges" can improve communication.
- The proposed "bridge" categories, including "bridge to palliative care," offer a clearer alternative to "bridge to nowhere."
- This framework aims to enhance ethical decision-making and patient communication in ECMO contexts.
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