Should Extracorporeal Membrane Oxygenation Be Offered? An International Survey

Pediatric ECMO Research: The Case for Collaboration

“…A similar trial has not been conducted in children, however recent results from a secondary analysis of the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) trial suggest that a trial of ECMO vs. continued conventional management for severe pediatric ARDS may be justified ( 18 ). The authors' conclusion was based on lack of differences in patient outcomes comparing RESTORE study participants managed with ECMO vs. matched controls managed with conventional mechanical ventilation, along with the finding of wide variability in clinical practice with regards to mechanical ventilation strategies and determination of ECMO candidacy and timing for ECMO cannulation that confirmed previously published survey data ( 18 , 19 ). To summarize, ECMO as intervention may become the focus of future trials in pediatrics for selected pathologies or novel indications.…”

“…being successfully supported on ECMO ( 24 – 26 ). It is unlikely that equipoise still exists for randomization to ECMO vs. continued conventional treatment for some ECMO indications in children (e.g., post-operative cardiogenic shock, cardiac arrest), but there is still variability in practices related to decision-making for ECMO cannulation that may be large enough to warrant ongoing evaluation for presence of equipoise for specific indications or for the timing or the means of applying the technology, as described in the previous section (e.g., pediatric ARDS) ( 19 ). That being said, methodological challenges to a RCT of ECMO vs. continued conventional treatment are numerous and potentially difficult to overcome, thus prospective data collection with data quality reviews at an international level over time may represent a better option to determine and monitor appropriate utilization of ECMO in pediatric critical care.…”

Can the Principles of Research Ethics Help Us Distribute Clinical Resources More Fairly?

“…quality of life, benefit vs. burden, etc.) but reaching different prioritization schemes (Kuo et al 2017). This scenario is not dissimilar to disagreements that may occur among members of institutional review boards (IRBs) reviewing eligibility criteria for clinical trials.…”

Eliciting Narratives to Inform Care for Infants With Trisomy 18

“…5 In a survey of extracorporeal membrane oxygenation (ECMO) medical directors facing 5 scenarios of ECMO candidacy, the lowest ECMO acceptability score was in the scenario of an infant with trisomy 18. 6 In a 2017 survey of 30 Canadian cardiologists, most (67%) supported comfort care for affected patients with a heart lesion, and none supported surgery for those with complex heart lesions. 7 Wide variations are now reported in cardiac surgical outcomes for infants with trisomy 18.…”