Most end-of-life treatment conflicts concern more familiar
interventions such as ventilators, dialysis, and CANH. Clinicians are far more comfortable
withholding and withdrawing less familiar and exotic interventions such as ECMO. Therefore, this report in the March 2012 ICU Director comes
as a surprise. After two failed lung
transplants, a patient was maintained on ECMO for 34 days. Her physicians did not think that this was
medically appropriate. So, then why was
it done? It was done, apparently, because of the
legal and reputational risks that the patient’s parents threatened.
There is enormous variability across physicians and institutions
regarding use of ventilators, dialysis, and CANH in the ICU. Is that same variability invading (and
undoing the standard of care for) other ICU interventions?
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