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 | ✓ |