The DOI matches its Crossref record.
Ethical challenges of adult ECMO
Open accessAbstract
The use of extracorporeal membrane oxygenation (ECMO) is expanding rapidly, and as more centres streamline their management policies, the bioethics literature on ECMO has been highlighting the ethical challenges of using an expensive, resource-intensive technology including its eligibility, duration of support, cost-effectiveness and societal repercussions. The absence of high-quality studies on long-term outcomes of ECMO survivors leads to multiple ethical problems involving patient autonomy, beneficence and clinical wisdom pertaining to its initiation, maintenance and termination. This article reviews some of the ethical challenges that affect decision-making during ECMO therapy and suggests an ethical framework that may help the treating team deal with such conundrums, when the patient does not recover despite being on ECMO.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Nonetheless, ECMO presents major challenges: initiation requires precise timing within a narrow therapeutic window, and complications such as bleeding, thrombosis, and infection remain common7,8.”
From Decisional conflict among Chinese family caregivers prior to ECMO initiation: a cross-sectional study (2025) · cites this paper as [8]
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
No references could be resolved yet.
Research works printed but not linked: 20
- Ramanathan K, Cove ME, Caleb MG, Teoh KL, Maclaren G. Ethical dilemmas of adult ECMO: emerging conceptual challenges. J Cardiothorac Vasc Anesth. 2015;29:229–33. · DOI
- Dalle Ave AL, Gardiner D, Shaw DM. The ethics of extracorporeal membrane oxygenation in brain-dead potential organ donors. Transpl Int. 2016;29:612–8. · DOI
- Bein T, Brodie D. Understanding ethical decisions for patients on extracorporeal life support. Intensive Care Med. 2017;43:1510–1. · DOI
- Dalle Ave AL, Bernat JL. Uncontrolled donation after circulatory determination of death: a systematic ethical analysis. J Intensive Care Med. 2018;33:624–34. · DOI
- Henry B, Verbeek PR, Cheskes S. Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: ethical considerations. Resuscitation. 2019;137:1–6. · DOI
- Eisenberg MS, Cummins RO, Larsen MP. Numerators, denominators, and survival rates: reporting survival from out-of-hospital cardiac arrest. Am J Emerg Med. 1991;9:544–6. · DOI
- Miles SH. Informed demand for "non-beneficial" medical treatment. N Engl J Med. 1991;325:512–5. · DOI
- Paris JJ, Schreiber MD, Statter M, Arensman R, Siegler M. Beyond autonomy--physicians' refusal to use life-prolonging extracorporeal membrane oxygenation. N Engl J Med. 1993;329:354–7. · DOI
- Chen YY, Chen L, Huang TS, et al. Significant social events and increasing use of life-sustaining treatment: trend analysis using extracorporeal membrane oxygenation as an example. BMC Med Ethics. 2014;15:21. · DOI
- Calman KC. The ethics of allocation of scarce health care resources: a view from the centre. J Med Ethics. 1994;20:71–4. · DOI
- Abrams D, Ferguson ND, Brochard L, et al. ECMO for ARDS: from salvage to standard of care? Lancet Respir Med. 2019;7:108–10. · DOI
- Abrams DC, Prager K, Blinderman CD, Burkart KM, Brodie D. Ethical dilemmas encountered with the use of extracorporeal membrane oxygenation in adults. Chest. 2014;145:876–82. · DOI
- Prager KM, Oz M. Proposed policy for VAD removal. Ann Thorac Surg. 2002;73:1688. · DOI
- Herridge MS, Tansey CM, Matte A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364:1293–304. · DOI
- Kon ZN, Dahi S, Evans CF, Byrnes KA, et al. Long-term venovenous extracorporeal membrane oxygenation support for acute respiratory distress syndrome. Ann Thorac Surg. 2015;100:2059–63. · DOI · Paper page
- Raza T. 300 plus days on ECMO – lessons learned. Qatar Med J. 2017. https://doi.org/10.5339/qmj.2017.swacelso.49. · DOI
- Courtwright AM, Robinson EM, Feins K, et al. Ethics committee consultation and extracorporeal membrane oxygenation. Ann Am Thorac Soc. 2016;13:1553–8. · DOI
- Gamulka BD. Ethical uncertainty: an approach to decisions involving extracorporeal membrane oxygenation. CMAJ. 1994;150:565–8.
- Cooper Z, Courtwright A, Karlage A, Gawande A, Block S. Pitfalls in communication that lead to nonbeneficial emergency surgery in elderly patients with serious illness: description of the problem and elements of a solution. Ann Surg. 2014;260:949–57. · DOI
- Mulaikal TA, Nakagawa S, Prager KM. Extracorporeal membrane oxygenation bridge to no recovery. Circulation. 2019;139:428–30. · DOI
Cited by
Xiao, S., Liu, H., Tang, L., Xiong, Q., Jiang, R., & Hong, D. (2025) · Scientific Reports · doi:10.1038/s41598-025-28709-9 · Cited by 1
Metadata
- Authors
- Ramanathan, K.
- Affiliations
- Bond University (AU)
- Corresponding author
- Ramanathan, Kollengode
- Venue
- Indian Journal of Thoracic and Cardiovascular Surgery
- Published
- 2020-02-17
- Volume
- 37
- Issue
- S2
- Pages
- 303-308
- ISSN
- 0970-9134 (ISSN-L)
- 0973-7723
- PMC
- PMC8062656
- OpenAlex
- W3007895549
- Cited by
- 13
- References
- 0
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 2 · 2022: 1 · 2021: 1
- FWCI
- 0.48
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Indian Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Ethics and Legal Issues in Pediatric Healthcare
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Mechanical Circulatory Support Devices
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- extracorporeal membrane oxygenation, adult ECMO, bioethics, patient autonomy, beneficence, withdrawal of life-sustaining treatment, cost-effectiveness, resource allocation, ethical decision-making framework
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
How to cite
Cite CoChat for the checks on this page, and the paper for its own findings.
- This page
- CoChat. (2026). Citation check: Ethical challenges of adult ECMO. https://app.cochat.ai/papers/10.1007/s12055-020-00922-3
- The paper
- Ramanathan, K. (2021). Ethical challenges of adult ECMO. Indian Journal of Thoracic and Cardiovascular Surgery. https://doi.org/10.1007/s12055-020-00922-3
