Ethical Considerations In Relation To Extracorporeal Membrane Oxygenation

1497 words - 6 pages

Introduction
As medical technology continues to advance, options to treat what were once thought to be fatal conditions continue to increase. Extracorporeal membrane oxygenation (ECMO) has been used since the 1970s and became a common therapy for newborns with respiratory failure (Rehder, Turner, & Cheifetz, 2011). Despite ECMO’s proven pediatric use, there are still ethical concerns over this therapy. There are concerns over the expense of this particular therapy in relation to results (Richards & Joubert, 2013). There are also multiple complications that can occur while using ECMO, and recently the expansion of using ECMO in adults with acute respiratory distress syndrome (ARDS), using ECMO as a bridging therapy while awaiting organ transplantation, and also using ECMO to maintain organ perfusion in organ donation have all brought up ethical considerations. Research is ongoing to further explore these issues.
The Basics of ECMO
ECMO is an external cardiopulmonary bypass circuit that serves to temporarily replace the functions of the heart and lungs. This necessitates the surgical placement of a catheter into a central vein located near the heart and a second catheter that can be placed in either a different central vein (VV ECMO), which is used for respiratory support, or placed into artery (VA ECMO), used when the patient requires cardiac and respiratory support. These catheters are connected to the ECMO machine where the blood is pumped through an oxygenator where carbon dioxide is removed and oxygen instilled (http://nyp.org/services/carf/what-is-ecmo.html).
ECMO has an established history of being used as a pediatric modality with critically ill patients as a last life-saving effort. Yet, there still is controversy regarding extending this treatment option into the adult population (MacLaren, Combes, & Bartlett, 2012). Adult ECMO is gaining popularity in its use in the final treatment option in acute respiratory distress syndrome (ARDS) and “awake ECMO” as a bridging therapy for organ transplantation.
Financial Costs of ECMO
One ethical debate surrounding ECMO are the costs this intervention incurs, as “ECMO patients were more resource demanding than average ICU patients” (Mishra et al., 2009, p. 340). The study by Mishra et al. calculated two different costs associated with ECMO, which included the daily cost for ECMO in the ICU and total cost, and these costs took into consideration additional personnel required to initiate and maintain the ECMO therapy, as well as other hospital costs for drugs and supplies. It is important to note that these calculations are based upon costs in 2007. The mean cost for a total ECMO hospitalization was $210,142 with the median cost of $191,436. The cost specifically for the ECMO intervention was a mean of $73,122 with a median cost of $62,545 (Mishra et al., 2009). Of the 14 patients in this study, Mishra et al. reported eight were able to be taken off the ECMO machine, three patients...

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