Extracorporeal Membrane Oxygenation Ethics: A Call for Action

Extracorporeal membrane oxygenation (ECMO) is a relatively novel, intensive medical intervention. It is known to raise important yet unsettled ethical concerns.

We established the ECMO Ethics Workgroup in 2021 to improve our understanding of these ethical issues and their possible resolutions. This paper explains the methods used to produce our insights and recommendations, which additional papers from the project elaborate on in detail. Initially, over 6 months, the 37 group members described the full range of ethical issues in ECMO care they were familiar with from experience, interpretation of relevant scholarship, and in response to our discussions. After we identified 5 major ethical themes and several subthemes for analysis, the group restructured into smaller writing groups. Each group performed narrative and meta-narrative reviews targeting the themes of experiencing ECMO, starting ECMO, stopping ECMO, specialist consultants involved in ECMO care, and "other" themes. In addition to summarizing our insights and recommendations regarding 4 of these themes, this paper recommends revising the common conceptualization of ECMO therapy in terms of "bridges." To improve communication about ECMO care, we propose 3 categories of ECMO bridges-therapeutic, potentially therapeutic, and nontherapeutic, including the idea of "bridge to palliative care" in lieu of the concept of "bridge to nowhere."