SCCM Resource Library-A Bridge Too Far? Controversies in the Initiation and Discontinuation of Extracorporeal Life Support

Video Transcription

Video Summary

In this congress session, clinicians discuss controversies surrounding the initiation and discontinuation of extracorporeal life support (ECLS), also known as ECMO. ECLS is a support device used in patients with severe respiratory or cardiac failure. The session begins with a discussion on ECLS candidacy, highlighting the history of ECLS and how candidacy has evolved over time. The speakers emphasize the importance of individualized decision-making based on patient factors and available resources. They also discuss the role of time-limited trials, in which the therapy is continued if the patient improves, but discontinued if the patient deteriorates. The session then focuses on discontinuation of ECLS, including the challenges in framing discussions with patients and families. It is important to provide clear guidance on prognosis and alternate treatment options, while respecting patient and family goals and values. The speakers stress the importance of a multidisciplinary approach in decision-making, including the involvement of palliative care, spiritual care, and other relevant specialists. The session concludes by discussing the options for navigating disagreements and conflicts that may arise in decision-making. Overall, the session highlights the need for shared decision-making, individualized care, and ongoing communication with patients and families.

Asset Subtitle

Ethics End of Life, Procedures, 2021

Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Learning Objectives

Examine decision-making challenges surrounding initiation and discontinuation of extracorporeal life support (ECLS) in contemporary intensive care practice utilizing ECLS technology
Recognize current controversies and practice variability surrounding patient selection for initiation of ECLS and timing of ECLS discontinuation and compare and contrast issues across adult and pediatric settings
Construct an approach to ethical decision-making and apply communication strategies in framing conversations with patients and surrogate decision-makers in discontinuation of ECLS support

Getting on the Bridge: ECLS Candidacy
Wynne E. Morrison

Getting off the Bridge: Discontinuation of ECLS
Daniel Brodie

Navigating the Bridge: Approaching Decision-Making and Framing Discussions
Katie Moynihan

Meta Tag

Content Type Presentation

Knowledge Area Ethics End of Life

Knowledge Area Procedures

Knowledge Level Advanced

Learning Pathway Skills and Procedures

Membership Level Select

Tag Extracorporeal Membrane Oxygenation ECMO

Tag Communication

Year 2021

Keywords

ECLS

ECMO

candidacy

time-limited trials

discontinuation

patient factors

multidisciplinary approach

prognosis

alternate treatment options

shared decision-making

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