Re:ECMO pumps blood out of the body, oxygenates it and retur...
by JoshTriplett on Thursday June 20, 2019 @07:25PM
(#20238469)
> A third argument arose, Truog said: If leaving this patient on ECMO was appropriate, then in fairness “why don’t we put everyone with respiratory failure on ECMO?”
That's not an argument against, that's an argument for. Why don't we? The only reason not to would be cost.
He was 'seriously sick', but he had a certain quality of life that was unusual for ECMO patients.
...The boy was fully conscious, doing homework, texting friends and visiting with family. But after two months of living in the ICU, he was diagnosed with untreatable cancer that made him ineligible to receive new lungs.
Clinicians were deeply divided over what to do next, Truog said. Some wanted to stop ECMO immediately because its original goal — a bridge to transplantation — was no longer possible.
Others argued that even though he couldn’t survive outside the ICU, the boy seemed to have a good quality of life on ECMO, and his family and friends “derived benefits from his continued survival,” Truog wrote. They argued that the family should have the right to continue this form of life support, just as with dialysis, ventilation or an artificial heart.
A third argument arose, Truog said: If leaving this patient on ECMO was appropriate, then in fairness “why don’t we put everyone with respiratory failure on ECMO?”
For the parents, Truog said, it was “unbearable” to choose a day or moment to turn off ECMO, because they knew their child would immediately die.
Clinicians devised an alternative the family would agree to: They decided not to replace the ECMO oxygenator, a part that needs to be changed every week or two when it develops blood clots. After about a week, the oxygenator gradually failed and the patient lost consciousness and died, Truog said.
The solution “allowed him to die in a way where we didn’t feel like we were choosing the moment of his death,” he said....