Extracorporeal membrane oxygenation as a bridge to decision or recovery: Medical and ethical dilemmas

Extracorporeal life support has advanced from its humble beginnings over 3 decades ago, with the first description of its success in a patient with Acute Respiratory Distress Syndrome (ARDS), going as far back as 1971. The indications for extracorporeal membrane oxygenation (ECMO) therapy include refractory respiratory and/or cardiac failure, and ECMO is now being increasingly used in adult patients. In this case report, we present a patient who had traveled from India to the United States, where she developed acute decompensated biventricular failure and shock, requiring ECMO placement as a bridge to a decision. During her first few days on ECMO, the patient lost intrinsic cardiac rhythm. However, her multiple organ dysfunction as well as her neurological status improved and were maintained by ECMO support. Further work-up indicated that the patient was not a candidate for heart transplant or for a permanent ventricular-assist device. The patient and her family were persistent in her desire to live, and ECMO was continued until the patient recovered from the acute decompensation of her chronic heart failure. ECMO was weaned with the appropriate pharmacological support. The patient was switched over to oral heart failure medications, transferred to a rehabilitation facility, and discharged to home in 1 month.