Determining the End of Life in Extracorporeal Membrane Oxygenation Patients: Concept Analysis

Introduction: extracorporeal membrane oxygenation (ecmo) has emerged as a major advancement in the treatment of critically ill patients, and has shown to be truly life-saving in otherwise hopeless situations. over-utilization of this technology in end-stage patients, often referred to as ―bridge to nowhere‖ is emerging as a medical and ethical dilemma. determining ―end of life‖ in ecmo patients, in other words, when to ―call it quits‖, is a controversial and unclear concept, and to date this phenomenon has not been defined or clarified in a systematic method. this study aimed to clarify and define the ―end of life‖ point to help in decision-making for withdrawal or termination of treatment for patients undergoing ecmo treatment. methods: relevant studies from pubmed, scopus, web of science, and google scholar were extracted from 1980 to 2021 using predesigned keywords. two authors separately screened the titles, abstracts, and the methodological validity of the articles utilizing a valid extraction form. discussions with the third author were utilized to resolve the disagreements during the review step. also, two authors independently assessed the quality of the studies. results: fourteen studies were selected: three cross-sectional and eleven retrospective or prospective cohort studies. four key attributes were identified: brain death, failure to bridge from ecmo to transplantation, myocardial failure, and multi-organ failure. several antecedents were identified, including age, lactate levels (pre-ecmo), creatinine and bilirubin levels, hematocrit level, mechanical ventilation parameters (pre-ecmo), arterial blood gas (pre-ecmo pao2<70mmhg), renal function (need for continuous renal replacement therapy – crrt - during ecmo), sofa score before ecmo, multi-organ failure, complications on ecmo, duration of ecmo and time of weaning from ecmo, lower annual hospital volume of ecmo and experience with ecmo.conclusion: the main concepts for describing the end of life in ecmo patients are brain death and multi-organ failure. however, there are scientific and ethical limitations with any medical recommendations to determine the end of life for ecmo patients precisely.