Ethical Considerations in Ever-Expanding Utilization of ECLS: A Research Agenda
Open Access
- 19 May 2022
- journal article
- research article
- Published by Frontiers Media SA in Frontiers in Pediatrics
- Vol. 10, 896232
- https://doi.org/10.3389/fped.2022.896232
Abstract
Technological advancements and rapid expansion in the clinical use of extracorporeal life support (ECLS) across all age ranges in the last decade, including during the COVID-19 pandemic, has led to important ethical considerations. As a costly and resource intensive therapy, ECLS is used emergently under high stakes circumstances where there is often prognostic uncertainty and risk for serious complications. To develop a research agenda to further characterize and address these ethical dilemmas, a working group of specialists in ECLS, critical care, cardiothoracic surgery, palliative care, and bioethics convened at a single pediatric academic institution over the course of 18 months. Using an iterative consensus process, research questions were selected based on: (1) frequency, (2) uniqueness to ECLS, (3) urgency, (4) feasibility to study, and (5) potential to improve patient care. Questions were categorized into broad domains of societal decision-making, bedside decision-making, patient and family communication, medical team dynamics, and research design and implementation. A deeper exploration of these ethical dilemmas through formalized research and deliberation may improve equitable access and quality of ECLS-related medical care.Keywords
This publication has 57 references indexed in Scilit:
- Extracorporeal membrane oxygenation for critically ill adultsEmergencias, 2015
- Clinical Research in Acute Fatal IllnessJournal of Intensive Care Medicine, 2014
- Position Paper for the Organization of Extracorporeal Membrane Oxygenation Programs for Acute Respiratory Failure in Adult PatientsAmerican Journal of Respiratory and Critical Care Medicine, 2014
- Ethical Dilemmas Encountered With the Use of Extracorporeal Membrane Oxygenation in AdultsSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2014
- Neurological injury after extracorporeal membrane oxygenation use to aid pediatric cardiopulmonary resuscitationPediatric Critical Care Medicine, 2009
- Extracorporeal Life Support in Pediatric and Neonatal Critical Care: A ReviewJournal of Intensive Care Medicine, 2004
- Extracorporeal life support for severe pediatric respiratory failure: An updated experience 1991–1993The Journal of Pediatrics, 1994
- Thinking Critically in Medicine and its Ethics: relating applied science and applied ethicsJournal of Applied Philosophy, 1987
- Part I. The Development of the First Successful Heart-Lung MachineThe Annals of Thoracic Surgery, 1982
- Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective studyJAMA, 1979