Department of Critical Care, The Hospital for Sick Children, Toronto, Canada; Department of Bioethics, The Hospital for Sick Children, Toronto, Canada; Department of Pediatrics, University of Toronto, Toronto, Canada.
Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, PA.
Semin Perinatol. 2018 Mar;42(2):129-137. doi: 10.1053/j.semperi.2017.12.009. Epub 2018 Jan 10.
ECMO has proven to be a life-saving intervention for a variety of disease entities with a high rate of survival in the neonatal population. However, ECMO requires clinical teams to engage in many ethical considerations. Even with ongoing improvements in technology and expertise, some patients will not survive a course of ECMO. An unsuccessful course of ECMO can be difficult to accept and cause a great deal of angst. These questions can result in real conflict both within the care team, and between the care team and the family. Herein we explore a range of ethical considerations that may be encountered when caring for a patient on ECMO, with a particular focus on those courses where it appears likely that the patient will not survive. We then consider how a palliative care approach may provide a tool set to help engage the team and family in confronting the difficult decision to discontinue ECMO.
ECMO 已被证明是一种挽救生命的干预措施，可用于多种疾病实体，在新生儿群体中的存活率很高。然而，ECMO 需要临床团队考虑许多伦理问题。即使技术和专业知识不断进步，一些患者仍无法在 ECMO 治疗中幸存。ECMO 治疗失败可能难以接受，并导致极大的焦虑。这些问题不仅会在护理团队内部，还会在护理团队和患者家属之间引发真正的冲突。本文探讨了在 ECMO 治疗患者时可能遇到的一系列伦理问题，特别关注那些患者似乎不太可能存活的情况。然后，我们考虑姑息治疗方法如何提供一套工具，帮助团队和家属面对停止 ECMO 的艰难决定。
