An expert workgroup of 37 members (ECMO Ethics Workgroup, formed 2021) conducted narrative and meta-narrative reviews across five major ethical themes in ECMO care: experiencing ECMO, starting ECMO, stopping ECMO, specialist consultants in ECMO care, and miscellaneous 'other' themes.
The workgroup proposes replacing the singular 'bridge' conceptual framework with three distinct categories — **therapeutic**, **potentially therapeutic**, and **non-therapeutic** bridges — and introduces 'bridge to palliative care' as a more honest alternative to the term 'bridge to nowhere.'
No primary data collected; insights are derived from expert experience and narrative/meta-narrative review only. The full recommendations are distributed across companion papers not yet reviewed here. The workgroup composition and selection process may introduce expert bias.
When ECMO cannot lead to a meaningful clinical outcome, clinicians should reframe the conversation as 'bridge to palliative care' rather than 'bridge to nowhere' — a shift that may support more honest goals-of-care discussions. Adopting the three-bridge framework (therapeutic, potentially therapeutic, non-therapeutic) at the time of ECMO initiation can help set clearer expectations with patients and families.
