Determining the end of life in extracorporeal membrane oxygenation patients: Concept Analysis

Extracorporeal membrane oxygenation (ECMO) has emerged as a major advancement in treatment of critically ill patients, and has shown to be truly life-saving in otherwise hopeless situations. This study aimed to clarify and define the point of “end of life” to help in decision-making for withdrawal or termination of treatment for patients undergoing ECMO treatment.

Pubmed, Scopus, Web of Science and Google Scholar were searched from1980 to 2021. Primary studies with English texts conducted on ECMO were selected based on PRISMA guidelines. After quality assessments, the data were analyzed using the Walker and Avant methods.

Fourteen studies were selected: three studies were cross-sectional and eleven were 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.

The main concepts for description of end of life in ECMO patients are brain death and multi-organ failure. There still are however scientific and ethical limitations with any medical recommendations to precisely determine the end of life for ECMO patients.