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Table 1 Comparison between survey participants’ responses, current ECMO allocation guidelines (ELSO), and current ethical algorithms and recommendations for rationing life-sustaining treatment during the COVID-19 pandemic

From: Ethical factors determining ECMO allocation during the COVID-19 pandemic

Ethical factors prioritised in ECMO allocation during COVID-19 pandemic (i.e. resource scarcity)
  Save the most lives Younger patients Equality of opportunity Healthcare workers Do not allocate on first-come-first-served basis Participants of COVID-19 clinical trials Reallocate ECMO if required to maximise overall benefit
Survey participants
Older patients less likely to survive ECMO
X X N/A X
Largely neutral
ECMO allocation guidelines (ELSO)
Lowest co-morbidities
X X N/A N/A
Ethical algorithm (Savulescu et al.)
Predicted length and quality of life (QALY)

Save the most lives; and desert-based

Desert-based (i.e. contracted COVID-19 at work)

Temporal neutrality
N/A
Ethical recommendations (Emanuel et al.)
Save more lives, and more years of life

Prioritise young, severely ill patients (more likely to recover with treatment)

Apply the same principles to COVID-19 and non-COVID-19 patients

Desert-based (for ventilators), and instrumental value (for testing/PPE/ICU beds)

Instrumental value; and desert-based