DNR and ECMO: a paradox worth exploring.

TitleDNR and ECMO: a paradox worth exploring.
Publication TypeJournal Article
Year of Publication2014
AuthorsMeltzer ECowen, Ivascu NS, Fins JJ
JournalJ Clin Ethics
Date Published2014 Spring
KeywordsDecision Making, Extracorporeal Membrane Oxygenation, Humans, Medical Futility, Resuscitation Orders, Terminal Care, Third-Party Consent, Withholding Treatment

Extracorporeal membrane oxygenation (ECMO) provides continuous circulation and/or oxygenation to adults with cardiac failure, pulmonary dysfunction, or both. The technology is similar to the traditional heart-lung bypass machines used during surgical procedures, however ECMO may be used outside the confines of the operating room and for extended periods of time. This paper explores the complexities, both clinical and ethical, of a do-not-resuscitate (DNR) order for patients with cardiopulmonary failure on veno-arterial (VA-ECMO), a type of ECMO that provides resuscitation superior to the chest compressions that DNR is intended to prevent. Clinically, a DNR order has limited utility for patients on VA-ECMO and its presence can serve to create confusion. Symbolically, however, the designation may serve as a stepping-stone for surrogates facing difficult end-of-life decisions. The paper concludes by suggesting that it is prudent to avoid DNR discussions in the context of VA-ECMO

Alternate JournalJ Clin Ethics
PubMed ID24779313