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Comment by FuriouslyAdrift | Hacker News Reader

ECMO is a last resort type treatment that has common life altering side effects.

Yep. A good friend of mine who is a perfusionist (a relatively obscure midlevel med tech role focused on ECMO/CPB operations) has made it clear they would rather just be allowed to die than be subjected to either. The majority of cases they're involved with, but most especially the ECMO cases, per their account, are associated with what seems like unnecessary suffering pending death. Their opinion is that in most cases, it's probably not worth the extreme cost and effort, and that tracking 'survival' as the criteria for success is misguided given poor quality of life afterwards, and usually death related to long-term side effects/complications. They admit that their opinion may be clouded by the fact that they've self-selected into working in hospitals that are the most likely to take 'hopeless' cases, though.

I'm a paramedic, and in between seeing quality of life issues post resuscitation, ongoing care challenges and, unfortunately, the state of some skilled nursing and rehab facilities, myself, and I would say a "very very large percentage" of my peers are absolutely on the same page.

Unless full recovery with no to minimal deficits is likely, not so much.

I have heard the sentiment before that ICU doctors would rather die than go through the ICU. Couple this with PTSD being a common side effect from ICU care and it starts to make a picture that maybe death is just the way to go.

No. This is not at all a representative opinion among ICU docs.

Definitely not a universal opinion. But it seems pretty common among my physician friends to have fairly specific advance directives that choose death over prolonged (or any) ICU stay in worst-case type scenarios. They keep bugging me to set something up like that for myself.

I am not just saying the original claim wasn’t universal, I’m saying it’s at most a tiny minority opinion (because it’s so extreme, taken literally).

“You should put your wishes in an advanced directive so you don’t suffer in the ICU in ~hopeless situations” (true) and “there are a non-negligible number of cases where the suffering in the ICU is not worth the modest life extension according the patient’s own values” (also true) and “the balance between life extension and quality of life errs, on average, too much toward the former” (plausibly true) are nothing like “the ICU is worse than death for most people”.

I spent a month in the ICU many years ago. I have the benefit that the trauma was front-loaded (motorcycle accident) so not too many horrible things happened to me in the last three weeks (although getting re-intubated ranks pretty high up there), but I don't have any hint of PTSD from the experience. N=1 and all that...

Doctors live very stressful lives from which there is often no escape until they finally retire someday.

It does not surprise me that many would choose to just die ASAP if something bad happened to them.

ECMO is used by emergency service in Paris and they it bring to the patient wherever he is having a cardiac arrest. This is really changing how many people will survive a out of hospital cardiac arrest, as a lot of people saved can resume a normal life (about 40% from 6% without it)

If you understand French here is a video of how the procedure is done. https://youtu.be/bX5yZFM2Dn4?si=h0hod5XXgWCWrfLa

Je le parle :)

SAMU's program is impressive and shows a lot of promise as a bridge treatment, and it's completely unlike anything available here in the US today (where myself and the friend I mentioned earlier live).

They even did it in the Louvre!

It helped some COVID patients to survive. Great technology.

This is common conversation doctors have amongst themselves and with patient’s family. In cases of premature births with complications, often doctors suggest not having the child on ECMO unless the chances of survival are really high.

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