Division of Pediatric Surgery, Department of Surgery, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa.
Division of Pediatric Surgery, Department of Surgery, University of Chicago Comer Children's Hospital, Chicago, Illinois, USA.
Curr Opin Pediatr. 2020 Jun;32(3):411-415. doi: 10.1097/MOP.0000000000000901.
As we have refined our extracorporeal membrane oxygenation (ECMO) capabilities and enhanced our ability to care for children with illnesses previously deemed lethal, the patient populations for whom ECMO is a medically appropriate intervention have expanded. Such expansion has prompted consideration of evolving ethical issues. In this review, we highlight several of the emerging ethical issues in pediatric ECMO.
Expansion of ECMO into increasingly diverse pediatric populations has prompted several ethical questions. First, some have found that there are specific clinical settings in which ECMO ought to be obligatory. Second, expanded use of ECMO may prompt disagreements among healthcare providers or between providers and family members regarding decisions about decannulation. Finally, analysis of the ethical challenges associated with integration of other disruptive healthcare modalities into patient care, will allow us insight into how to assure ethical expansion of pediatric ECMO.
Expansion of pediatric ECMO highlights several ethical issues including whether ECMO is ever ethically obligatory, how to ethically decannulate a patient when survival is deemed unlikely, and how to guide expansion of pediatric ECMO based upon lessons learned from the implementation of other disruptive healthcare interventions into practice.
随着我们体外膜肺氧合（ECMO）技术的不断完善和对以前被认为致命疾病患儿的治疗能力的提高，ECMO 作为一种医学上合理的干预手段，其适用患者群体不断扩大。这种扩张引发了对不断发展的伦理问题的考虑。在这篇综述中，我们强调了儿科 ECMO 中出现的几个新的伦理问题。
ECMO 扩展到越来越多样化的儿科人群中，引发了一些伦理问题。首先，有些人认为在某些特定的临床环境中，ECMO 应该是强制性的。其次，ECMO 的广泛应用可能会在医疗保健提供者之间或提供者与家属之间就拔管决定产生分歧。最后，对将其他颠覆性医疗模式整合到患者护理中所带来的伦理挑战的分析，将使我们能够深入了解如何确保儿科 ECMO 的伦理扩张。
儿科 ECMO 的扩展突出了几个伦理问题，包括 ECMO 是否在任何情况下都是强制性的、当生存被认为不太可能时如何在伦理上拔管患者，以及如何根据将其他颠覆性医疗干预措施引入实践的经验教训来指导儿科 ECMO 的扩展。
