Extracorporeal cardiopulmonary resuscitation dissemination and integration with organ preservation in the USA: ethical and logistical considerations
Abstract Use of extracorporeal membrane oxygenation (ECMO) in cardiopulmonary resuscitation, termed eCPR, offers the prospect of improving survival with good neurological function after cardiac arrest. After death, ECMO can also be used for enhanced preservation of abdominal and thoracic organs, des...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-04-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-023-04432-7 |
| _version_ | 1797841036957974528 |
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| author | Tamar Schiff Christian Koziatek Erin Pomerantz Nichole Bosson Robert Montgomery Brendan Parent Stephen P. Wall |
| author_facet | Tamar Schiff Christian Koziatek Erin Pomerantz Nichole Bosson Robert Montgomery Brendan Parent Stephen P. Wall |
| author_sort | Tamar Schiff |
| collection | DOAJ |
| description | Abstract Use of extracorporeal membrane oxygenation (ECMO) in cardiopulmonary resuscitation, termed eCPR, offers the prospect of improving survival with good neurological function after cardiac arrest. After death, ECMO can also be used for enhanced preservation of abdominal and thoracic organs, designated normothermic regional perfusion (NRP), before organ recovery for transplantation. To optimize resuscitation and transplantation outcomes, healthcare networks in Portugal and Italy have developed cardiac arrest protocols that integrate use of eCPR with NRP. Similar dissemination of eCPR and its integration with NRP in the USA raise novel ethical issues due to a non-nationalized health system and an opt-in framework for organ donation, as well as other legal and cultural factors. Nonetheless, eCPR investigations are ongoing, and both eCPR and NRP are selectively employed in clinical practice. This paper delineates the most pressing relevant ethical considerations and proposes recommendations for implementation of protocols that aim to promote public trust and reduce conflicts of interest. Transparent policies should rely on protocols that separate lifesaving from organ preservation considerations; robust, centralized eCPR data to inform equitable and evidence-based allocations; uniform practices concerning clinical decision-making and resource utilization; and partnership with community stakeholders, allowing patients to make decisions about emergency care that align with their values. Proactively addressing these ethical and logistical challenges could enable eCPR dissemination and integration with NRP protocols in the USA, with the potential to maximize lives saved through both improved resuscitation with good neurological outcomes and increased organ donation opportunities when resuscitation is unsuccessful or not in accordance with individuals’ wishes. |
| first_indexed | 2024-04-09T16:24:26Z |
| format | Article |
| id | doaj.art-d07ef574987b4603b6354fe3e6d2fbfc |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-04-09T16:24:26Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-d07ef574987b4603b6354fe3e6d2fbfc2023-04-23T11:18:42ZengBMCCritical Care1364-85352023-04-0127111010.1186/s13054-023-04432-7Extracorporeal cardiopulmonary resuscitation dissemination and integration with organ preservation in the USA: ethical and logistical considerationsTamar Schiff0Christian Koziatek1Erin Pomerantz2Nichole Bosson3Robert Montgomery4Brendan Parent5Stephen P. Wall6Department of Population Health, NYU Langone HealthRonald O. Perelman Department of Emergency Medicine, NYU Langone HealthLewis Katz School of Medicine at Temple UniversityLos Angeles County EMS AgencyNYU Langone Transplant Institute, NYU Langone HealthDepartment of Population Health, NYU Langone HealthDepartment of Population Health, NYU Langone HealthAbstract Use of extracorporeal membrane oxygenation (ECMO) in cardiopulmonary resuscitation, termed eCPR, offers the prospect of improving survival with good neurological function after cardiac arrest. After death, ECMO can also be used for enhanced preservation of abdominal and thoracic organs, designated normothermic regional perfusion (NRP), before organ recovery for transplantation. To optimize resuscitation and transplantation outcomes, healthcare networks in Portugal and Italy have developed cardiac arrest protocols that integrate use of eCPR with NRP. Similar dissemination of eCPR and its integration with NRP in the USA raise novel ethical issues due to a non-nationalized health system and an opt-in framework for organ donation, as well as other legal and cultural factors. Nonetheless, eCPR investigations are ongoing, and both eCPR and NRP are selectively employed in clinical practice. This paper delineates the most pressing relevant ethical considerations and proposes recommendations for implementation of protocols that aim to promote public trust and reduce conflicts of interest. Transparent policies should rely on protocols that separate lifesaving from organ preservation considerations; robust, centralized eCPR data to inform equitable and evidence-based allocations; uniform practices concerning clinical decision-making and resource utilization; and partnership with community stakeholders, allowing patients to make decisions about emergency care that align with their values. Proactively addressing these ethical and logistical challenges could enable eCPR dissemination and integration with NRP protocols in the USA, with the potential to maximize lives saved through both improved resuscitation with good neurological outcomes and increased organ donation opportunities when resuscitation is unsuccessful or not in accordance with individuals’ wishes.https://doi.org/10.1186/s13054-023-04432-7Extracorporeal membrane oxygenationCardiopulmonary resuscitationOrgan donationOrgan preservationBioethics |
| spellingShingle | Tamar Schiff Christian Koziatek Erin Pomerantz Nichole Bosson Robert Montgomery Brendan Parent Stephen P. Wall Extracorporeal cardiopulmonary resuscitation dissemination and integration with organ preservation in the USA: ethical and logistical considerations Critical Care Extracorporeal membrane oxygenation Cardiopulmonary resuscitation Organ donation Organ preservation Bioethics |
| title | Extracorporeal cardiopulmonary resuscitation dissemination and integration with organ preservation in the USA: ethical and logistical considerations |
| title_full | Extracorporeal cardiopulmonary resuscitation dissemination and integration with organ preservation in the USA: ethical and logistical considerations |
| title_fullStr | Extracorporeal cardiopulmonary resuscitation dissemination and integration with organ preservation in the USA: ethical and logistical considerations |
| title_full_unstemmed | Extracorporeal cardiopulmonary resuscitation dissemination and integration with organ preservation in the USA: ethical and logistical considerations |
| title_short | Extracorporeal cardiopulmonary resuscitation dissemination and integration with organ preservation in the USA: ethical and logistical considerations |
| title_sort | extracorporeal cardiopulmonary resuscitation dissemination and integration with organ preservation in the usa ethical and logistical considerations |
| topic | Extracorporeal membrane oxygenation Cardiopulmonary resuscitation Organ donation Organ preservation Bioethics |
| url | https://doi.org/10.1186/s13054-023-04432-7 |
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