Abstract: Cardiac arrest has significant associated morbidity and mortality. Out-of-hospital cardiac arrest (OHCA) has extremely high mortality with close to 90% of patients not surviving the index hospitalization. Extracorporeal membrane oxygenation (ECMO) has been traditionally used for cardiac failure and respiratory failure, but is increasingly being utilized for cardiac arrest, known as extracorporeal cardiopulmonary resuscitation (ECPR). ECPR is showing promise for reducing mortality and morbidity, such as neurologic injury, from cardiac arrest. As ECMO is increasingly utilized for ECPR, multiple potential ethical questions arise. While data on ECPR shows a promising trend towards reduced morbidity and mortality, there are conflicting results and an overall paucity of data. ECMO has significant associated risks and it is crucial to ensure that we are not inadvertently causing more harm than benefit. Another potential problem arises when choosing which patients receive ECPR. Protocols and individual clinician choices about when to provide ECPR may contain biases about factors such as race, age, and gender that create unjust allocation. In addition, ECMO is a scarce resource that requires specialized staff and intensive care unit (ICU) bed availability. As ECPR is increasingly utilized, problems with resource allocation will arise, which may lead to poor outcomes for other patients, such as planned cardiac surgery cases that are delayed. It is imperative to further evaluate the many ethical dilemmas arising as ECPR becomes increasingly incorporated into standard cardiac arrest care.
After participating in this conference, attendees should be able to:
ECMO can be utilized during cardiac arrest as ECPR, but current data has not shown a clear morbidity and mortality benefit, and ECMO may cause significant harm.
Biases may exist in ECPR protocols and individual clinician assessments about when to provide ECPR care, which may result in unjust allocation.
ECMO is a scarce resource and increased use of ECMO for ECPR may result in problems with resource allocation and impact patient outcomes.
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