Ethical and end of life considerations for neonates requiring ECMO support

Kirsch, Roxanne; Munson, David

doi:10.1053/j.semperi.2017.12.009

Cited by 39 publications

(57 citation statements)

References 60 publications

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“…This paper focuses on using ECPR for cerebral-CPR. In this context, ECMO technology is generally applied for the purpose of (1) bridge-to-recovery by providing time for diagnostic procedures and/or therapeutics to be delivered (e.g., acute arrhythmia following cardiac surgery, or from electrolyte disturbance with loss of cardiac output and refractory to conventional therapy, acute myocarditis with complex arrhythmias or heart block, patient with residual lesions after cardiac surgery who could undergo additional surgery or intervention in the catheterization laboratory); (2) bridge-to-organ transplantation or as a means to bridging to decision with another device—to consider organ transplantation; or for (3) bridge-to-decision , which includes decision to continue, decision to stop advanced technological support, and to bridge to palliative care plan ( 21 ).…”

Section: Patient Selectionmentioning

confidence: 99%

Establishing and Sustaining an ECPR Program

Laussen

Guerguerian

2018

Front. Pediatr.

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The use of extracorporeal support after failed return of a spontaneous ciruculation during cardiopulmonary resuscitation (ECPR) is well described. There are 4 distinct phases for resuscitation with ECPR and the time spent in each phase is critical for successful outcome. Recommendations for ECPR previously published by the American Heart Association provide the context for implementing a consistent and well-rehearsed system for ECPR, by people with the knowledge, experience and resources to deploy ECPR in the most optimal time frame possible in selected patient populations. In this manuscript we review the current status of ECPR for acute cardiac failure and the components we believe are necessary to develop and sustain a reliable and resilient program.

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Section: Patient Selectionmentioning

confidence: 99%

Establishing and Sustaining an ECPR Program

Laussen

Guerguerian

2018

Front. Pediatr.

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“…23 Utilization of ECMO has resulted in ethical debates about autonomy, nonmaleficence, informed consent, resource allocation, and the advancement of medicine. 24,25 ECMO now has an expanded role including-at times-for patients with active malignancies who need short-term support to recovery, but this role can necessitate discussions of withdrawal of ECMO support if there is no clinical improvement. 26,27 A central ethical question in BJ's case is how to express regard for the child's best interest using emerging technology amidst disagreement between clinical team members and parental decision makers.…”

Section: Guidelines For Shared Decision Making About New Technology Usementioning

confidence: 99%

Should Physicians Offer a Ventricular Assist Device to a Pediatric Oncology Patient With a Poor Prognosis?

Patel

Joong

Lelkes

et al. 2019

AMA Journal of Ethics

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“…9 These laws are, however, not final, and more work must be done to create guidelines for stopping ECMO life support. 10 Ethics committee consultation should be taken, which can yield recommendations and some clarifying explanations that support the final decisions to end ECMO care among patient's family members and members of ECMO care team. This can delay unwarranted legal action.…”

Section: Do Not Resuscitate/dnar: Since the Original Inceptionmentioning

confidence: 99%

Are We Clinicians Away from Ethics?

Choudhury

Kapoor

2018

J Card Crit Care

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Medicine has always stood at the intersection between science and society. From antiquity to the present, everyone has faced health challenges that prompted the formation of groups of healers and the development of codes of ethics to govern the treatments that they offered. Medical codes of ethics blend the moral precepts, normative behavior, and social duties of the population in which they are used, and they change as new medical therapies and social issues arise. The written codes of ethics are based on modern terms for many of the issues raised in Charak Samhita. They also represent an effort to codify the essence of “the clinical encounter between physician and patient” and the role of society while emphasizing the importance of compassion, beneficence, nonmaleficence, respect for persons, and accountability. Medical ethics have been an integral part of Charak Samhita and its complete incorporation in present-day medical teaching and clinical practice will yield great results to this noble profession. Is it true that we clinicians are away from practice of ethics in medicine? Are we not following a structural approach to identify, analyze, and resolve ethical issue in clinical practice? We as clinicians should have some working knowledge about informed consent, confidentiality, patient's rights, and end-of-life care. At times, clinicians and patients disagree about the choices that may challenge their lives. It is then that ethical problem rises. While dealing with a patient, ethical problem can be avoided when the case is analyzed in four important areas: medical/surgical indications, preference by patient, quality of life with or without treatment, and other circumstantial features, for example socioeconomic, legal, or administrative aspects of the case.

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Ethical and end of life considerations for neonates requiring ECMO support

Cited by 39 publications

References 60 publications

Establishing and Sustaining an ECPR Program

Establishing and Sustaining an ECPR Program

Should Physicians Offer a Ventricular Assist Device to a Pediatric Oncology Patient With a Poor Prognosis?

Are We Clinicians Away from Ethics?

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