Ethical Dilemmas in Pediatric Extracorporeal Cardiopulmonary Resuscitation: Qualitative Study of Interprofessional Perspectives

OBJECTIVES: Interprofessional perspectives on the ethical dilemmas associated with pediatric extracorporeal cardiopulmonary resuscitation (ECPR) are underexplored in the literature. In this study we aimed to explore interprofessional perspectives on pediatric ECPR and the ethical dilemmas encountered by healthcare teams. DESIGN: Descriptive, exploratory, qualitative study using semi-structured interviews. SETTING: Noncardiac PICU at a quaternary care academic center in the United States. PARTICIPANTS: Fifteen pediatric providers from general surgery, noncardiac intensive care, and perfusion. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Semi-structured interviews were conducted between December 2022 and April 2023. Interviews were audio recorded and professionally transcribed verbatim. Using a constructivist grounded theory approach, interviews were coded by an interprofessional team using qualitative software. Interviewing continued until thematic saturation was reached. Codes were organized into common themes using the constant comparative method and discussed in iterative multidisciplinary meetings. Themes were analyzed through a virtues-based ethical framework to better characterize the ethical motivations guiding professional perspectives. We identified five major themes, including 1) informed consent; 2) decision-making authority; 3) past experiences; 4) end-of-life care; and 5) resource allocation. CONCLUSIONS: In this single-center study carried out 2022-2023, we explored interprofessional perspectives on the ethical complexities in pediatric ECPR. Viewing these themes through a virtues-based ethical perspective may offer a structured approach to facilitate team dialogue. Further research is needed to determine whether this approach influences clinical decision-making and impacts team alignment.