Ethical factors determining ECMO allocation during the COVID-19 pandemic.
Ethical factors determining ECMO allocation during the COVID-19 pandemic.
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DOI：
10.1186/s12910-021-00638-y
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发表时间：
2021-06-01
影响因子：
2.7
通讯作者：
Wilkinson DJC
中科院分区：
文献类型：
--
作者：
Dao B;Savulescu J;Suen JY;Fraser JF;Wilkinson DJC
在新冠肺炎大流行期间，ECMO是一种特别稀缺的资源。它的分配涉及到可能与平时不同的伦理考量。关于ECMO医生在ECMO分配期间考虑的伦理因素，大流行前的文献有限。在大流行期间，专门关于道德和ECMO分配的专业指导相对较少；尽管关于其他危重护理资源的分配存在着积极的道德辩论。我们报告了一项小型国际探索性调查的结果，调查对象是体外反搏临床医生在新冠肺炎大流行之前和期间对体外反搏决策中不同患者因素的看法。然后，我们概述了新冠肺炎大流行期间配给维持生命治疗的当前伦理决策程序和建议，并审查了当前的体外循环管理分配指南(和已报告的实践)在多大程度上符合这些伦理准则和建议。进行了一项在线调查，记录了2020年5月中旬至8月中旬期间的回复。参与者(n = 48人)来自ECMO卡研究小组，这是一个国际专家组(n = 120)，参与了一项关于ECMO和新冠肺炎大流行期间患者重症监护的前瞻性国际研究。这项调查比较了在大流行之前和期间对ECMO资源分配中涉及的某些道德因素进行考虑的程度。与平时相比，在大流行期间启动体外循环术时，参与者报告称，与已经接受体外循环术的患者相比，尚未入院的其他患者给予体外循环术更多的道德权重(p <； 0.001)。如果一个完整的单元被推荐为ECMO的良好候选者，在大流行期间，参与者更有可能考虑停止存活机会较低的当前患者的ECMO(在大流行期间为53%，而在p = 0.002之前为33%)。如果临床小组建议ECMO停止，但家人不同意，大多数参与者表示他们将继续治疗，无论是在正常情况下(67%)还是在大流行期间(56%)。我们发现，在新冠肺炎大流行期间，在ECMO分配的背景下，几个伦理因素的优先顺序有所不同。调查参与者优先考虑的伦理原则与幼儿保育组织分配指南、当前的伦理决策程序以及新冠肺炎大流行期间维持生命治疗的分配建议基本一致。网上版载有补充材料，可在10.1186/s12910-021-00638-y查阅。
ECMO is a particularly scarce resource during the COVID-19 pandemic. Its allocation involves ethical considerations that may be different to usual times. There is limited pre-pandemic literature on the ethical factors that ECMO physicians consider during ECMO allocation. During the pandemic, there has been relatively little professional guidance specifically relating to ethics and ECMO allocation; although there has been active ethical debate about allocation of other critical care resources. We report the results of a small international exploratory survey of ECMO clinicians’ views on different patient factors in ECMO decision-making prior to and during the COVID-19 pandemic. We then outline current ethical decision procedures and recommendations for rationing life-sustaining treatment during the COVID-19 pandemic, and examine the extent to which current guidelines for ECMO allocation (and reported practice) adhere to these ethical guidelines and recommendations. An online survey was performed with responses recorded between mid May and mid August 2020. Participants (n = 48) were sourced from the ECMOCard study group—an international group of experts (n = 120) taking part in a prospective international study of ECMO and intensive care for patients during the COVID-19 pandemic. The survey compared the extent to which certain ethical factors involved in ECMO resource allocation were considered prior to and during the pandemic. When initiating ECMO during the pandemic, compared to usual times, participants reported giving more ethical weight to the benefit of ECMO to other patients not yet admitted as opposed to those already receiving ECMO, (p < 0.001). If a full unit were referred a good candidate for ECMO, participants were more likely during the pandemic to consider discontinuing ECMO from a current patient with low chance of survival (53% during pandemic vs. 33% prior p = 0.002). If the clinical team recommends that ECMO should cease, but family do not agree, the majority of participants indicated that they would continue treatment, both in usual circumstances (67%) and during the pandemic (56%). We found differences during the COVID-19 pandemic in prioritisation of several ethical factors in the context of ECMO allocation. The ethical principles prioritised by survey participants were largely consistent with ECMO allocation guidelines, current ethical decision procedures and recommendations for allocation of life-sustaining treatment during the COVID-19 pandemic. The online version contains supplementary material available at 10.1186/s12910-021-00638-y.
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DOI：
10.15557/pimr.2020.0003
发表时间：
2020-01-01
影响因子：
3.6
作者：
通讯作者：
--
影响因子：
5.5
作者：
Leclerc, Thomas;Donat, Nicolas;Veber, Benoit
通讯作者：
Veber, Benoit
影响因子：
8.8
作者：
Abrams, Darryl;Pham, Tai;Ranieri, V. Marco
通讯作者：
Ranieri, V. Marco
影响因子：
8.4
作者：
Amzat, Jimoh;Aminu, Kafayat;Danjibo, Maryann C.
通讯作者：
Danjibo, Maryann C.
影响因子：
5.1
作者：
Kuo, Kevin W.;Barbaro, Ryan P.;Odetola, Folafoluwa O.
通讯作者：
Odetola, Folafoluwa O.