Guiding Providers in the Face of Uncertainty
Extracorporeal life support (ECLS) is an advanced form of life support for patients whose heart and lungs do not respond to conventional life support, such as drugs that stimulate the heart to beat and mechanical ventilation to help the lungs work. It uses a machine to bypass the heart and lungs. A blood pump and oxygenator outside the body takes the patient’s blood, removes carbon dioxide and adds oxygen. This processed blood is pumped back into the patient, doing the work of the heart, the lungs, or both.
Traditionally used in newborns and children for rescue situations, ECLS now represents the standard approach for an ever-expanding number of childhood medical conditions. The expanded use of ECLS brings up ethical dilemmas; being attentive to the ethical dilemmas may mitigate the burdens for patients, families, staff members and healthcare systems. We need to ask just because we can use this, should we?
Bioethics faculty members and pediatric critical care medicine physicians Drs. Mithya Lewis-Newby and Jonna D. Clark formed the Seattle Ethics in ECLS (SEE) Consortium in 2012 with a dozen other providers and researchers, including Drs. Benjamin Wilfond and Ross Hays. In the past year, the SEE Consortium identified 38 research priorities; the next step is to select a specific research project to advance.
What makes ECLS so complex? It:
- Is resource-intensive, requiring highly trained medical personnel and expensive equipment
- Is used in life-or-death medical situations, when decisions may be desperate and families have little time to make the decision and are under stress
- Involves significant risk, with serious complications being common (including stroke and other forms of brain injury)
“Each factor may exist in isolation in other areas of medicine; however, in ECLS all of these factors collide into a ‘perfect storm’ that creates distress for the patient, family and the healthcare providers.”
“Bioethics is entwined with all aspects of advanced life support and can include topics around communications, family and staff support, and decision making. Ultimately we want to improve the quality of ECLS-related medical care.”
For more information, see Examining palliative care team involvement in automatic consultations for children on extracorporeal life support in the pediatric intensive care unit. J Palliat Med. 2013 May;16 (5):492-5.
To make sure that technological advancement of ECLS does not create an undue burden for patients and families, and that resources are allocated justly and responsibly.
- Harris Baden, Seattle Children’s
- Tom Brogan, Seattle Children’s
- Lin Di Gennaro, Seattle Children’s
- Robert Mazor, Seattle Children’s
- Joan Roberts, Seattle Children’s
- Helene Starks, University of Washington
- Ardith Doorenbos, University of Washington
- Mike McMullan, University of Washington
- Robert Truog, Harvard School of Medicine