Extracorporeal life support, ethics, and questions at the bedside: how does the end of the pathway look?

Experienced intensivists, cardiologists and perfusion- ists come together at the bedside of a 75-year-old patient on extracorporeal life support (veno-arterial ECMO). This patient has had €˜successful €™ resuscitation after myocardial infarction and now has a beating heart and cannulae in situ. There are moderate signs of brain hypoxemia, increasing bilirubin, compromised renal function, and sustained pressor dependence over the past week. The patient remains too unstable to wean from ECMO. We are at a loss with therapy and also perspective. Is the goal quantity of life or quality of life? Have we interrupted the biological process of dying with extracorporeal machines (according to Rene` Descartes)?


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