Veno-venous extracorporeal membrane oxygenation for the acute respiratory distress syndrome: a bridge too far?
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) provides a bridge to recovery in patients with acute respiratory failure due to the acute respiratory distress syndrome (ARDS). Survival in ARDS has improved over 15 years, and VV-ECMO may rescue even the most severe of these patients. Predictors of survival on ICU are based upon the principles of reversibility of the inciting aetiology, and premorbid ‘reserve’ – an imprecise term encompassing comorbidities and frailty. ECMO can support failing organs for prolonged periods, thus sometimes masking trajectories of decline, or unmasking irretrievable intrinsic conditions at a later time point in the critical illness. Clinicians are confronted with new on-treatment dilemmas: how long should we continue this high level of care? Will the patient’s limited respiratory reserve manage off ECMO? Or are we hastening their demise? How long is it justifiable to keep someone on ECMO, if the predicted survival off is ultimately poor, but they are in a stable state whilst supported? The palliative withdrawal from ECMO is unchartered territory that requires further study. We describe two representative cases and discuss the wide ethical issues surrounding the initiation and withdrawal of ECMO.
Date Issued
2021-01-04
Date Acceptance
2020-10-20
Citation
Acta Cardiologica: an international journal of cardiology, 2021, 76 (5), pp.455-458
ISSN
0001-5385
Publisher
Taylor & Francis
Start Page
455
End Page
458
Journal / Book Title
Acta Cardiologica: an international journal of cardiology
Volume
76
Issue
5
Copyright Statement
© 2020 Belgian Society of Cardiology. This is an Accepted Manuscript of an article published by Taylor & Francis in Acta Cardiologica on 04 Jan 2021], available online: https://www.tandfonline.com/doi/full/10.1080/00015385.2020.1841971
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000604358100001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Veno-venous extracorporeal membrane oxygenation
acute respiratory distress syndrome
ethics
palliative
end of life
FAILURE
Publication Status
Published
Date Publish Online
2021-01-04