Clinician Perspectives on the Extracorporeal Membrane Oxygenation Decision-Making Process

In patients for whom venovenous extracorporeal membrane oxygenation (VV ECMO) may be medically indicated, how do clinicians approach candidacy determinations and consider different variables in the decision-making process?In this qualitative study of 24 physicians and ECMO coordinators from 9 countries, decisions to pursue VV ECMO for patients were largely based on clinical judgments of suitability rather than objective guidelines. Determining patient candidacy may be based on flexible interpretations of patient characteristics, biases, and social contexts.The findings showed that, as ECMO is better understood and adopted in critical care medicine, ethical questions remain about how VV ECMO candidacy is variably determined.

Corresponding Author: Derek R. Soled, MD, MBA, MSc, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115 (dsoled@bwh.harvard.edu).

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