• Resuscitation · Nov 2016

    Review

    Extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation or uncontrolled donation after the circulatory determination of death following out-of-hospital refractory cardiac arrest-An ethical analysis of an unresolved clinical dilemma.

    • Anne L Dalle Ave, David M Shaw, and Dale Gardiner.
    • Ethics Unit, University Hospital of Lausanne, Rue du Bugnon 21, 1011 Lausanne, Switzerland; Institute for Biomedical Ethics, University Medical Center, 1, Rue Michel-Servet, 1211 Geneva 14, Switzerland. Electronic address: Anne.Dalle-Ave@chuv.ch.
    • Resuscitation. 2016 Nov 1; 108: 87-94.

    BackgroundThe availability of extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation (E-CPR), for use in refractory out-of hospital cardiac arrest (OHCA), is increasing. In parallel, some countries have developed uncontrolled donation after circulatory determination of death (uDCDD) programs using ECMO to preserve organs for transplantation purposes.AimWhen facing a refractory OHCA, how does the medical team choose between initiating ECMO as part of an E-CPR protocol or ECMO as part of a uDCDD protocol?MethodsTo answer these questions we conducted a literature review on E-CPR compared to uDCDD protocols using ECMO and analyzed the raised ethical issues.ResultsOur analysis reveals that the inclusion criteria in E-CPR and uDCDD protocols are similar. There may be a non-negligible risk of including patients in a uDCDD protocol, when the patient might have been saved by the use of E-CPR.ConclusionIn order to avoid the fatal error of letting a saveable patient die, safeguards are necessary. We recommend: (1) the development of internationally accepted termination of resuscitation guidelines that would have to be satisfied prior to inclusion of patients in any uDCDD protocol, (2) the choice regarding modalities of ongoing resuscitation during transfer should be focused on the primary priority of attempting to save the life of patients, (3) only centers of excellence in life-saving resuscitation should initiate or maintain uDCDD programs, (4) E-CPR should be clinically considered first before the initiation of any uDCDD protocol, and (5) there should be no discrimination in the availability of access to E-CPR.Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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