AUTHOR=Clark Jonna D. , Baden Harris P. , Berkman Emily R. , Bourget Erica , Brogan Thomas V. , Di Gennaro Jane L. , Doorenbos Ardith Z. , McMullan D. Michael , Roberts Joan S. , Turnbull Jessica M. , Wilfond Benjamin S. , Lewis-Newby Mithya , Seattle Ethics in ECLS (SEE) Consortium TITLE=Ethical Considerations in Ever-Expanding Utilization of ECLS: A Research Agenda JOURNAL=Frontiers in Pediatrics VOLUME=10 YEAR=2022 URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2022.896232 DOI=10.3389/fped.2022.896232 ISSN=2296-2360 ABSTRACT=

Technological advancements and rapid expansion in the clinical use of extracorporeal life support (ECLS) across all age ranges in the last decade, including during the COVID-19 pandemic, has led to important ethical considerations. As a costly and resource intensive therapy, ECLS is used emergently under high stakes circumstances where there is often prognostic uncertainty and risk for serious complications. To develop a research agenda to further characterize and address these ethical dilemmas, a working group of specialists in ECLS, critical care, cardiothoracic surgery, palliative care, and bioethics convened at a single pediatric academic institution over the course of 18 months. Using an iterative consensus process, research questions were selected based on: (1) frequency, (2) uniqueness to ECLS, (3) urgency, (4) feasibility to study, and (5) potential to improve patient care. Questions were categorized into broad domains of societal decision-making, bedside decision-making, patient and family communication, medical team dynamics, and research design and implementation. A deeper exploration of these ethical dilemmas through formalized research and deliberation may improve equitable access and quality of ECLS-related medical care.