As with almost everything in healthcare, weighing the benefits of a therapy or support vs. the adverse effects of that therapy or support can result in widely variable opinions. I think most involved in ECMO support would agree that historically, many institutions too often use ECMO as a “last ditch effort”. Often we hear doctors tell families, “If we don’t put your loved on on ECMO now, they will die.” Or, “This is their only chance of surviving.” Or, “We have done everything we can do. The only other thing we have to try is ECMO.” And admittedly there is a subset of patients where this may be the case.However, I’d like to encourage you to consider that ECMO/ECLS should be more readily considered as a frontline life support modality initiated early in a disease process for the purpose of improving quality of life outcomes rather than just to attempt to save a life.
I recently came across this pair of opposing view editorials in the March 2015 edition of Intensive Care Medicine.
- Rescue therapy for refractory ARDS should be offered early: yes
- Rescue therapy for refractory ARDS should be offered early: no
The discussion is in regards to whether or not to begin ECMO as an early intervention (within 24 hours) for severe ARDS patients. I think both authors highlight the key support and dissension for both sides of the argument.
I was drawn to one statement made in the argument for “no” or slower use of ECMO. The author mentioned that one group was “able to avoid” the use of ECMO. My encouragement would be to change the mindset that ECMO is something to be “avoided”. If utilized appropriately and managed properly and performed with the proper equipment/circuitry, ECMO/ECLS use should be considered in order to IMPROVE patient outcomes rather than seen as something to “avoid”.
Can ECMO be done safely enough and with low enough rate of complications to move out of the category of “last ditch effort” to that of a desired mode of support to improve quality of life?
Share your thoughts with us.