ECMO and “Time of Death”
I know this is a very nuanced topic but have had interesting convos with perfusionists who argue that an asystolic patient on V-A ECMO is still “alive” when they have a MAP above 65. I had a patient who never stood a chance (that likely shouldn’t have gone on circuit) who was DNR after developing widespread gut ischemia per family wishes.
Of course before family is able to get there to withdraw as planned…. VT. They still wanted electricity so of course we try a chemical code, no dice then shock them to eventually get a ventricular escape that degrades quickly into asystole. They want to clamp circuit so we did so, but it begs the question — in a patient with loss of reflexes and fixed pupils who is showing clear signs of brain death without confirmatory testing, is their time of death asystole or when care is “withdrawn” when ECMO is discontinued?