Ethics and extracorporeal membrane oxygenation during coronavirus disease 2019 outbreak

Nardo, Matteo Di; Ore, Anna Dalle; Starr, Joanne P.; Cecchetti, Corrado; Amodeo, Antonio; Testa, Genni

doi:10.1177/0267659120937545

Cited by 7 publications

(8 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In this case, the patient will be returned to conventional therapy or consideration given for withdrawal of life-sustaining therapies (futility and principle of proportionate therapy). 35…”

Section: Weaning and Discontinuation Of Ecmomentioning

confidence: 99%

Extracorporeal Membrane Oxygenation for COVID-19: Updated 2021 Guidelines from the Extracorporeal Life Support Organization

et al. 2021

View full text Add to dashboard Cite

Disclaimer: This is an updated guideline from the Extracorporeal Life Support Organization (ELSO) for the role of extracorporeal membrane oxygenation (ECMO) for patients with severe cardiopulmonary failure due to coronavirus disease 2019 (COVID-19). The great majority of COVID-19 patients (>90%) requiring ECMO have been supported using venovenous (V-V) ECMO for acute respiratory distress syndrome (ARDS). While COVID-19 ECMO run duration may be longer than in non-COVID-19 ECMO patients, published mortality appears to be similar between the two groups. However, data collection is ongoing, and there is a signal that overall mortality may be increasing. Conventional selection criteria for COVID-19–related ECMO should be used; however, when resources become more constrained during a pandemic, more stringent contraindications should be implemented. Formation of regional ECMO referral networks may facilitate communication, resource sharing, expedited patient referral, and mobile ECMO retrieval. There are no data to suggest deviation from conventional ECMO device or patient management when applying ECMO for COVID-19 patients. Rarely, children may require ECMO support for COVID-19–related ARDS, myocarditis, or multisystem inflammatory syndrome in children (MIS-C); conventional selection criteria and management practices should be the standard. We strongly encourage participation in data submission to investigate the optimal use of ECMO for COVID-19.

show abstract

“…In this case, the patient will be returned to conventional therapy or consideration given for withdrawal of life-sustaining therapies (futility and principle of proportionate therapy). 35…”

Section: Weaning and Discontinuation Of Ecmomentioning

confidence: 99%

Extracorporeal Membrane Oxygenation for COVID-19: Updated 2021 Guidelines from the Extracorporeal Life Support Organization

et al. 2021

View full text Add to dashboard Cite

show abstract

“…9,10 Ramanathan et al have outlined the importance of balancing the four major ethical principlesbeneficence, nonmaleficence, autonomy, and justice-especially by relying on a robust shared decision-making framework. 11,12 Abrams et al have advocated for the utilitarian allocation principle (ie, maximizing benefits principle), meaning ECMO should be reserved for those who stand to derive the greatest amount of survival benefit. 13 Furthermore, regardless of the principle chosen, Emanuel et al emphasized the importance of collecting input from all affected parties (ie, the public) to be fair, consistent, and trustworthy.…”

Section: Discussionmentioning

confidence: 99%

How Should ECMO Be Used Under Conditions of Severe Scarcity? A Population Study of Public Perception

Han

Shin

Patrick

et al. 2022

Journal of Cardiothoracic and Vascular Anesthesia

View full text Add to dashboard Cite

Objective: To assess societal preferences regarding allocation of extracorporeal membrane oxygenation (ECMO) as a rescue option for select patients with coronavirus disease 2019 (COVID-19). Design: Cross-sectional survey of a nationally representative sample. Setting: Amazon Mechanical Turk platform. Participants: In total, responses from 1,041 members of Amazon Mechanical Turk crowd-sourcing platform were included. Participants were 37.9 § 12.6 years old, generally white (65%), and college-educated (66.1%). Many reported working in a healthcare setting (22.5%) and having a friend or family member who was admitted to the hospital (43.8%) or died from COVID-19 (29.9%). Measurements and Main Results: Although most reported an unwillingness to stay on ECMO for >one week without signs of recovery, participants were highly supportive of ECMO utilization as a life-preserving technique on a policy level. The majority (96.7%) advocated for continued use of ECMO to treat COVID patients during periods of resource scarcity but would prioritize those with highest likelihood of recovery (50%) followed by those who were sickest regardless of survival chances (31.7%). Patients >40 years old were more likely to prefer distributing ECMO on a first-come first-served basis (21.5% v 13.3%, p < 0.05). Conclusion: Even though participants expressed hesitation regarding ECMO in personal circumstances, they were uniformly in support of using ECMO to treat COVID patients at a policy level for others who might need it, even in the setting of severe scarcity.

show abstract

“…Se trata de una técnica invasiva, con una significativa tasa de complicaciones y un alto costo monetario, lo que puede presentar desafíos económicos para el sistema de salud (13) . Asimismo, se requiere de centros especializados de alta complejidad, que cuenten con un equipo multidisciplinario altamente entrenado y un adecuado juicio clínico-bioético para decidir su aplicación (14,15) . Los autores consideramos que el reporte de casos de pacientes con ECMO puede ayudar a determinar la utilidad de este método de soporte vital en COVID-19.…”

Section: Discussionunclassified

Membrana de circulación extracorpórea en enfermedad por coronavirus (COVID-19)

Bisso

Garbarini

Lockhart

et al. 2022

Rev Fac Cien Med Univ Nac Cordoba

View full text Add to dashboard Cite

Introducción: El uso de membrana de circulación extracorpórea (ECMO) en pacientes con síndrome de distrés respiratorio agudo (SDRA) es una medida de rescate que busca optimizar la oxigenación como puente a la rehabilitación pulmonar. Su rol en la enfermedad por coronavirus (COVID-19) no está definido, sin embargo, en pacientes con insuficiencia respiratoria hipoxémica refractaria, y con potencial de recuperación, su uso podría resultar beneficioso. Objetivo: El propósito de este trabajo es informar el primer caso de COVID-19 que requirió ECMO en Argentina, con buena respuesta. Metodología: Se describe el primer caso de COVID-19 que requirió ECMO en Argentina, en un paciente sin comorbilidades, con buen resultado clínico. Resultados: El uso de ECMO en el caso reportado aportó un sustancial beneficio en la oxigenación actuando como puente a la recuperación pulmonar, sin presentar complicaciones asociadas a su aplicación. Conclusión: En pacientes críticamente enfermos con hipoxemia refractaria, pero con potencial de recuperación, el soporte con ECMO puede ser considerado como una medida de rescate.

show abstract

Ethics and extracorporeal membrane oxygenation during coronavirus disease 2019 outbreak

Cited by 7 publications

References 17 publications

Extracorporeal Membrane Oxygenation for COVID-19: Updated 2021 Guidelines from the Extracorporeal Life Support Organization

Extracorporeal Membrane Oxygenation for COVID-19: Updated 2021 Guidelines from the Extracorporeal Life Support Organization

How Should ECMO Be Used Under Conditions of Severe Scarcity? A Population Study of Public Perception

Membrana de circulación extracorpórea en enfermedad por coronavirus (COVID-19)

Contact Info

Product

Resources

About