# A Bridge to Nowhere: Enabling Autonomy in a Case of Failed ECMO Rescue of Bleomycin-Induced Pulmonary Toxicity

## TL;DR

This paper discusses the challenges of making end-of-life decisions when ECMO fails to reverse severe bleomycin-induced lung injury in a young patient.

## Contribution

The paper highlights the ethical and clinical complexities of ECMO use in irreversible pulmonary toxicity cases.

## Key findings

- ECMO may obscure the true severity of irreversible lung injury.
- End-of-life decisions become harder when mechanical support maintains functionality.
- Young patients with prior full functionality face unique challenges in such scenarios.

## Abstract

Extracorporeal membrane oxygenation (ECMO) can be a life-saving intervention in cases of potentially reversible refractory respiratory failure. One such indication can be bleomycin-induced lung injury. However, in some cases, the injury can be so severe that it becomes irreversible and creates complex medical decisions regarding life support and the continuation of care when no additional therapeutic options are feasible, particularly in cases of patients who were young and fully functional prior to an acute illness. In cases of full pulmonary replacement with mechanical support and the degree of functionality that can be attained utilizing modalities such as ECMO can obscure the true severity of illness and make end-of-life decisions significantly harder for families and caregivers.