Ramanathan Kollengode
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, Singapore.
Indian J Thorac Cardiovasc Surg. 2021 Apr;37(Suppl 2):303-308. doi: 10.1007/s12055-020-00922-3. Epub 2020 Feb 17.
The use of extracorporeal membrane oxygenation (ECMO) is expanding rapidly, and as more centres streamline their management policies, the bioethics literature on ECMO has been highlighting the ethical challenges of using an expensive, resource-intensive technology including its eligibility, duration of support, cost-effectiveness and societal repercussions. The absence of high-quality studies on long-term outcomes of ECMO survivors leads to multiple ethical problems involving patient autonomy, beneficence and clinical wisdom pertaining to its initiation, maintenance and termination. This article reviews some of the ethical challenges that affect decision-making during ECMO therapy and suggests an ethical framework that may help the treating team deal with such conundrums, when the patient does not recover despite being on ECMO.
体外膜肺氧合（ECMO）的应用正在迅速扩展，随着越来越多的中心简化其管理政策，关于ECMO的生物伦理学文献一直在强调使用这种昂贵、资源密集型技术所面临的伦理挑战，包括其适用标准、支持时长、成本效益以及社会影响。缺乏关于ECMO幸存者长期预后的高质量研究导致了多个伦理问题，这些问题涉及患者自主权、医疗行善原则以及在ECMO启动、维持和终止方面的临床智慧。本文回顾了一些影响ECMO治疗决策的伦理挑战，并提出了一个伦理框架，当患者尽管接受了ECMO治疗仍未康复时，该框架可能有助于治疗团队应对此类难题。
