Continuing ECMO with No Possible Transition to Recovery or Transplant

I am delighted to announce the first of my team's new series of articles on ECMO is now available here at Lancet Respiratory Medicine: "Continuing ECMO with No Possible Transition to Recovery or Transplant." 

Controversy has emerged around how to treat patients who were placed on extracorporeal membrane oxygenation (ECMO) expecting recovery, organ transplant, or durable device, but who can no longer be transitioned to those goals. Many physicians hold that, in such cases, ECMO should be withdrawn, even over the objections of patients or their legally authorized representatives. Many other physicians, however, object to unilateral withdrawal.

Lancet also published a parallel commentary: "ECMO: more than just a bridge over troubled waters?"

Extracorporeal membrane oxygenation (ECMO) is used in severe cardiorespiratory failure refractory to conventional management, often as a bridge to recovery, long-term support, or transplant. However, some patients might not be candidates for destination therapy at the outset, and others might die or lose their candidacy due to complications, which are more likely the longer ECMO is continued. When patients remain ECMO-dependent with no prospects of recovery, and when they are not candidates for destination therapy, the patient, their next of kin, and the health-care team face an ethical dilemma: what next?