Every time I read about ECMO, the stories are saturated with weird comments by doctors and hospital officials about its “proper use”, whether they are doing the right thing to use it, etc. Explicitly they say the concern is for the patient (whether the potential suffering is worth it given the high chance of death), but I can’t square this with the numbers and with other medical practices. Unless there is some extreme physical torture associated with EMCO that’s not mentioned, being on EMCO for a week or month or 6 months seems obviously worth it for a 50% chance of survival from the patient’s perspective. Other patients with different illnesses routinely spend giant amounts of time in the ICU with much slimmer odds. Nothing I read in these articles suggests to me that ECMO stands out unusually above the high background levels of suffering in a modern hospital.
I suspect the underlying cause of the handwringing is the immense cost of ECMO (hundreds of thousands of dollars) and the distinct possibility that a patient ends up dependent on it (marginal cost >$5k per day) with no obvious ethical threshold for withdrawing care, at least according to the official prevailing norm that mere cost cannot be a reason to do so. This article is substantially more direct about that:
I suspect the underlying cause of the handwringing is the immense cost of ECMO (hundreds of thousands of dollars) and the distinct possibility that a patient ends up dependent on it (marginal cost >$5k per day) with no obvious ethical threshold for withdrawing care, at least according to the official prevailing norm that mere cost cannot be a reason to do so. This article is substantially more direct about that:
https://khn.org/news/miracle-machine-makes-heroic-rescues-an...
Very interested to hear commentary from people who know more though.