Ethical Considerations In Relation To Extracorporeal Membrane Oxygenation

1947 words - 8 pages

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 has become a common therapy for newborns with respiratory failure (Rehder, Turner, & Cheifetz, 2011). Despite ECMO’s increased pediatric survival rates, there are still ethical concerns over this therapy. There are worries over the expense of this particular therapy in relation to results (Richards & Joubert, 2013). The recent expansion of ECMO including use in adults with acute respiratory distress syndrome (ARDS), ECMO as a bridging therapy while awaiting organ ...view middle of the document...

History of ECMO
Prior to the application of ECMO in the early 1970s, there were numerous studies conducted that helped guide the pioneers to the implementation of ECMO. The most profound studies on how ECMO runs today were the experiments of Lee and Dobelle, as they were able to recognize that direct exposure of blood to oxygen gas was leading to severe toxicity. The direct exposure of blood to oxygen gas in this type of therapy became lethal within just a few days ("Extracorporeal Life Support," n.d.). Their observations led to more experimentation and to the development of an artificially made lung in which a gas-permeable membrane was placed between the blood and gas phase. The use of the gas-permeable membrane allowed gas exchange without direct gas interface ("Extracorporeal Life Support," n.d.). Additionally, the first successful membrane oxygenator was built with this concept in mind by using a polyethylene membrane, which allowed for permeability of oxygen and carbon dioxide.
With the foundation of membrane oxygenators, small modifications, and advancing technology, the first successful attempt at ECMO was reported early in the 1970s. ("Extracorporeal Life Support," n.d.). The patient was a young man with a ruptured aorta and was placed on venoarterial extracorporeal membrane oxygenation for three days to allow his heart and lungs to rest. The first successful neonatal patient placed on ECMO was in May of 1975. The patient was in respiratory failure, and ECMO therapy was implemented at the University of California Medical Center. After the successful treatment of one neonatal patient with ECMO, by 1981 ECMO therapy for neonates became standardized to include venoarterial access, heparin titration, and lung rest at low ventilator settings ("Extracorporeal Life Support," n.d.). Lastly, there are over 100 centers using ECMO support as a routine treatment for newborn infants who are experiencing respiratory failure and an additional 27 centers using ECMO support for adult respiratory failure.
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. These costs took into consideration additional personnel required to initiate and maintain ECMO therapy, as well as other hospital costs for drugs and other 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 eventually...

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