When considering the addition of ECLS to the emergency care available at a hospital, clinicians and administrators need to be mindful of costs, in particular the opportunity costs of developing an ECPR program in lieu of other initiatives that could improve the quality of resuscitative emergency care. Human resource requirements, including staffing, emergency response teams, and ongoing education, are significant.

ECMO and ECPR shouldn’t require a radical revamping of established ethical principles or best practices. However, ethical considerations in ECMO application should be considered proactively, keeping pace with resuscitative science. The resource intensity of ECMO care, the complexity of bridge-to-nowhere cases, and the uncertain role of ECMO in end-of-life conversations should serve as ethical limits to unconstrained growth of this technology, making sure the tail of technology isn’t wagging the dog of ethical practice.

Dr. Allen is director of healthcare ethics, Billings Clinic, Billings, Montana; and adjunct assistant professor of Medicine and Medical Ethics, Baylor College of Medicine, Houston, Texas.

Dr. Jesus is an attending physician, Augusta Medical Center, Fishersville, Virginia.

Dr. Knowles is director of leadership and advocacy for Integrative Emergency Services; and core faculty at John Peter Smith Health Network, Fort Worth, Texas.

Dr. Larkin is a professor at the University of Auckland/New York University.

Dr. Schears transitioned from the Mayo Clinic, is currently studying social justice and micro-economics at the Heller School in the inaugural year of the executive MBA program for physicians at Brandeis University.

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