title: Should Extracorporeal Membrane Oxygenation Be Offered? An International Survey.
abstract: OBJECTIVE
  To assess the current attitudes of extracorporeal membrane oxygenation (ECMO) program directors regarding eligibility for ECMO among children with cardiopulmonary failure.
  
  
  METHODS
  Electronic cross-sectional survey of ECMO program directors at ECMO centers worldwide within the Extracorporeal Life Support Organization directory (October 2015-December 2015).
  
  
  RESULTS
  Of 733 eligible respondents, 226 (31%) completed the survey, 65% of whom routinely cared for pediatric patients. There was wide variability in whether respondents would offer ECMO to any of the 5 scenario patients, ranging from 31% who would offer ECMO to a child with trisomy 18 to 76% who would offer ECMO to a child with prolonged cardiac arrest and indeterminate neurologic status. Even physicians practicing the same specialty sometimes held widely divergent opinions, with 50% of pediatric intensivists stating they would offer ECMO to a child with severe developmental delay and 50% stating they would not. Factors such as quality of life and neurologic status influenced decision making and were used to support decisions for and against offering ECMO.
  
  
  CONCLUSIONS
  ECMO program directors vary widely in whether they would offer ECMO to various children with cardiopulmonary failure. This heterogeneity in physician decision making underscores the need for more evidence that could eventually inform interinstitutional guidelines regarding patient selection for ECMO.
authors.affiliation: Division of Pediatric Critical Care, Department of Pediatrics, University of Michigan, Ann Arbor, MI. Electronic address: kkevin@med.umich.edu.
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Kuo
authors.affiliation: Division of Pediatric Critical Care, Department of Pediatrics, University of Michigan, Ann Arbor, MI.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Barbaro
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Samir K
authors.initials: SK
authors.lastname: Gadepalli
authors.affiliation: Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, IL.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Davis
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Bartlett
authors.affiliation: Division of Pediatric Critical Care, Department of Pediatrics, University of Michigan, Ann Arbor, MI.
authors.forename: Folafoluwa O
authors.initials: FO
authors.lastname: Odetola
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003657:Decision Making; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D011795:Surveys and Questionnaires
keywords: attitude; contraindications; decision making; extracorporeal membrane oxygenation; pediatrics; standards