Program, Development

Siddiqui, Shahla1; Arora, Lovkesh2; Wall, Michael3; Lupei, Monica3; Cobas, Miguel4; Demirilap, Gozde5; Bartz, Raquel6

1BIDMC, Boston, USA.

2University of Iowa, Iowa, USA.

3Univ of Minnesota, Minnesota, USA.

4Univ of Miami, Miami, USA.

5Univ of Wisconsin, Wisconsin, USA.

6Brigham and Women’s Hospital, Boston, USA

Introduction: We aimed to survey the members of 2 societies to assess the ethical and moral challenges faced by teams when initiating as well as managing patients requiring ECMO.

Methods: A simple 5-minute survey was sent to members of the ASA and ELSO.

Results: 60 participants responded to the survey as of July 2023. Only 68% of the participants who manage ECMO patients are involved in the ECMO initiation decision process. Of these, 80% are part of a team. The majority do not involve Ethics or Palliative care at the initial decision. 58%percent said their volumes are less than 100/ year. 70% do not have a separate consent process and in 87% of cases, a timeline is not adhered to for withdrawal. 55% do not have transplant surgeons involved in initiation decisions. Sixty percent do not have regular goals of care discussion and 70% of the participants reported that insurance or state of residence are irrelevant. Ethical issues involved: 1. Prognostication of patients receiving ECMO support, 2. Lack of knowledge of patient’s wishes, 3. Disconnect between expectations of families and outcomes and 4. Staff moral distress around when to stop.

Conclusion: Streamlining consent processes, involvement of transplant teams for candidacy for transplantation, structured and regular communication, the use of ethics and palliative care teams in family discussions and clear expectations can be some strategies which can mitigate moral distress and burnout among care providers as well as assist families in the sustained and prolonged ordeal after a devastating event.