Scenario Analysis: This scenario presents a significant professional challenge due to the rapid deterioration of a patient with complex cardiopulmonary pathophysiology and shock. The critical nature of extracorporeal life support (ECLS) demands immediate, accurate assessment and intervention. Misinterpreting the underlying shock syndrome or applying an inappropriate ECLS strategy can lead to irreversible organ damage, increased morbidity, and mortality. The need for a systematic, evidence-based approach is paramount, balancing immediate life-saving measures with a thorough understanding of the patient’s unique physiological state. Correct Approach Analysis: The best professional practice involves a comprehensive, multi-system assessment to precisely identify the predominant shock syndrome. This includes a detailed review of the patient’s history, physical examination findings (e.g., peripheral perfusion, heart sounds, lung sounds, abdominal distension), and a rapid integration of hemodynamic data (e.g., arterial and central venous pressures, cardiac output if available, lactate levels, mixed venous oxygen saturation). Based on this integrated assessment, the ECLS strategy should be tailored to address the specific pathophysiology. For instance, in cardiogenic shock, the focus would be on augmenting cardiac output and reducing preload/afterload. In septic shock, the priority would be on vasopressor support and source control, with ECLS used to bridge to recovery or definitive treatment. This approach aligns with best practice guidelines for ECLS management, emphasizing individualized care and a thorough understanding of shock etiologies as outlined by professional organizations such as the Extracorporeal Life Support Organization (ELSO). Ethical considerations mandate that interventions are evidence-based and patient-centered, aiming to provide the greatest benefit with the least harm. Incorrect Approaches Analysis: Initiating ECLS without a clear diagnostic hypothesis for the predominant shock syndrome is a significant ethical and professional failure. This “shotgun” approach risks applying an inappropriate modality or configuration of ECLS, potentially exacerbating the underlying condition or failing to address the primary insult. For example, initiating venoarterial (VA) ECLS for a patient with primarily pulmonary hypertension and right heart failure (which might be better managed with venovenous (VV) ECLS or other therapies) could lead to increased left ventricular afterload and further myocardial stunning. Similarly, relying solely on empiric vasopressor escalation without a comprehensive shock assessment ignores the potential for other reversible causes of shock and may mask critical information needed for effective ECLS management. This deviates from the principle of beneficence, as it may not lead to the best possible outcome for the patient. Failing to consider the reversibility of the underlying cause of shock before or concurrently with ECLS initiation is another critical failure. ECLS is a bridge therapy. If the underlying cause of shock (e.g., overwhelming sepsis, massive pulmonary embolism, acute myocardial infarction) is not being actively addressed, ECLS may prolong the dying process rather than facilitate recovery. This raises ethical concerns regarding resource utilization and the patient’s dignity. Professional Reasoning: Professionals should adopt a systematic diagnostic framework when managing patients with complex shock syndromes requiring ECLS. This involves: 1) Rapidly assessing the ABCs (Airway, Breathing, Circulation) and identifying immediate life threats. 2) Performing a focused history and physical examination to gather clues about the etiology of shock. 3) Utilizing available diagnostic tools (echocardiography, blood gas analysis, lactate, imaging) to refine the differential diagnosis of shock. 4) Formulating a working diagnosis of the predominant shock syndrome (e.g., cardiogenic, septic, obstructive, hypovolemic). 5) Selecting the most appropriate ECLS configuration (VV or VA) and initial support strategy based on the diagnosis and patient-specific factors. 6) Continuously reassessing the patient’s response to therapy and the underlying pathology, adjusting the ECLS strategy and medical management as needed. This iterative process ensures that ECLS is used judiciously and effectively to support the patient while definitive treatments are pursued.

The analysis reveals a scenario that is professionally challenging due to the inherent complexity of managing critically ill adult patients requiring extracorporeal life support (ECLS). The rapid deterioration of patients, the need for multidisciplinary team coordination, and the potential for life-threatening complications demand a high level of clinical judgment and adherence to established best practices. Careful consideration of patient-specific factors, team capabilities, and available resources is paramount to ensuring optimal outcomes and patient safety. The best professional practice involves a comprehensive, individualized assessment of the patient’s ECLS needs, considering their underlying pathology, hemodynamic stability, and potential for recovery. This approach prioritizes a thorough review of all available clinical data, including diagnostic imaging, laboratory results, and previous treatment responses, to inform the decision-making process. Furthermore, it necessitates open communication and collaborative discussion among the multidisciplinary ECLS team, including intensivists, perfusionists, nurses, and respiratory therapists, to reach a consensus on the most appropriate management strategy. This aligns with ethical principles of beneficence and non-maleficence, ensuring that interventions are tailored to the patient’s best interests and that risks are minimized. It also reflects the professional responsibility to practice within the scope of established guidelines and evidence-based medicine. An approach that focuses solely on initiating ECLS based on a single abnormal parameter, without a comprehensive assessment of the patient’s overall clinical picture, is professionally unacceptable. This overlooks the multifaceted nature of critical illness and the potential for alternative or adjunctive therapies. Such a narrow focus could lead to inappropriate ECLS initiation, exposing the patient to unnecessary risks and resource utilization without a clear benefit. Another professionally unacceptable approach would be to proceed with ECLS without robust multidisciplinary team consensus. This undermines the collaborative nature of critical care and can lead to fragmented care, communication breakdowns, and potential errors. The ethical principle of shared decision-making and the professional obligation to ensure comprehensive patient care are violated when critical treatment decisions are made in isolation. Finally, an approach that prioritizes resource availability over patient suitability for ECLS is ethically and professionally unsound. While resource limitations are a reality, the primary determinant for initiating life-sustaining interventions must always be the patient’s clinical need and potential for benefit. Diverting resources from a patient who could benefit to one who cannot, or vice versa, based solely on logistical convenience, is a failure of professional duty and violates the principle of justice in healthcare allocation. Professionals should employ a structured decision-making framework that begins with a thorough patient assessment, followed by a systematic evaluation of treatment options, including ECLS. This framework should incorporate interdisciplinary team consultation, consideration of patient and family preferences, and a continuous reassessment of the patient’s response to therapy. Adherence to institutional protocols and national/international guidelines for ECLS management is crucial.

This scenario is professionally challenging because determining eligibility for advanced adult extracorporeal life support (ECLS) competency assessment requires a nuanced understanding of both the patient’s clinical status and the established regulatory and institutional guidelines. Misjudging eligibility can lead to delayed or inappropriate interventions, impacting patient outcomes and potentially violating professional standards. Careful judgment is required to balance the urgency of critical illness with the need for rigorous competency validation. The best professional practice involves a comprehensive evaluation of the patient’s clinical trajectory and the specific criteria outlined by the relevant professional bodies and institutional protocols for advanced adult ECLS. This approach ensures that the assessment is initiated only when the patient’s condition demonstrably warrants the complexity and resource intensity of advanced ECLS, and that the assessment process itself is aligned with established standards of care and patient safety. This aligns with the principle of providing the highest level of care only when indicated and validated. Initiating an advanced adult ECLS competency assessment solely based on the presence of a severe, life-threatening condition without a thorough review of the patient’s specific clinical indicators and the established eligibility criteria for advanced ECLS is professionally unacceptable. This approach risks premature or unnecessary escalation of care, potentially exposing the patient to the risks associated with ECLS without a clear indication or a validated need for advanced competency. It fails to adhere to the principle of judicious resource allocation and evidence-based practice. Another professionally unacceptable approach is to delay the initiation of the competency assessment until the patient is in extremis, with minimal physiological reserve. While the patient’s condition may be severe, this delay can compromise the ability to conduct a thorough and meaningful assessment. It also fails to acknowledge the proactive nature of preparing for advanced ECLS, which often requires a structured and timely evaluation process to ensure readiness and optimize patient management. This approach can lead to a reactive rather than a proactive approach to patient care. Finally, proceeding with an advanced adult ECLS competency assessment based on the availability of resources or personnel, rather than the patient’s clinical need and established eligibility criteria, is ethically and professionally unsound. This prioritizes logistical convenience over patient-centered care and can lead to the misapplication of advanced ECLS, potentially diverting resources from patients who genuinely require it and undermining the integrity of the competency assessment process. Professionals should employ a decision-making framework that prioritizes patient needs, adheres strictly to established regulatory and institutional guidelines, and involves a multidisciplinary team approach. This framework should include a systematic review of clinical indicators, a clear understanding of the purpose and eligibility for advanced ECLS competency assessment, and a commitment to evidence-based practice and patient safety.

This scenario is professionally challenging due to the critical nature of extracorporeal life support (ECLS) and the inherent risks associated with mechanical ventilation and multimodal monitoring in critically ill adults. The need for rapid, evidence-based decision-making under pressure, coupled with the potential for significant patient harm, necessitates a rigorous approach to competency assessment. Careful judgment is required to ensure that practitioners not only possess theoretical knowledge but can also apply it effectively in complex clinical situations. The best professional practice involves a comprehensive assessment that integrates theoretical knowledge with practical application, focusing on the patient’s physiological response and the clinician’s ability to interpret and act upon multimodal data. This approach aligns with the ethical imperative to provide safe and effective patient care, as mandated by professional bodies that emphasize continuous learning and competency validation. It ensures that practitioners can synthesize information from various monitoring modalities and ventilation strategies to optimize ECLS management, thereby minimizing complications and improving patient outcomes. This aligns with the principles of patient advocacy and the duty of care inherent in advanced critical care. An approach that relies solely on theoretical knowledge without assessing practical application is professionally unacceptable. It fails to guarantee that the practitioner can translate understanding into safe clinical actions, potentially leading to errors in judgment or management. This overlooks the critical need for hands-on skill and real-time decision-making in ECLS. Another professionally unacceptable approach is one that prioritizes a single monitoring modality over a holistic, integrated assessment of the patient’s condition. ECLS management requires a comprehensive understanding of multiple physiological parameters. Focusing on isolated data points without considering their interplay can lead to misinterpretations and inappropriate interventions, jeopardizing patient safety. This neglects the principle of comprehensive patient assessment. Furthermore, an approach that does not consider the dynamic nature of ECLS and the patient’s response to interventions is flawed. Competency in ECLS requires the ability to adapt management strategies based on evolving clinical data. Failing to assess this adaptability means the practitioner may not be equipped to handle the unpredictable course of critically ill patients on ECLS, potentially leading to delayed or incorrect adjustments in therapy. This contravenes the principle of ongoing assessment and adaptation in critical care. The professional reasoning framework for such situations should involve a structured evaluation process that includes: 1) assessing the practitioner’s understanding of ECLS principles and mechanical ventilation strategies; 2) evaluating their ability to interpret and integrate data from multimodal monitoring (e.g., hemodynamics, respiratory mechanics, neurological status); 3) testing their decision-making skills in simulated or real-time scenarios involving ECLS management and troubleshooting; and 4) confirming their proficiency in performing ECLS-related procedures and managing potential complications. This multi-faceted approach ensures a robust assessment of advanced competency.

Scenario Analysis: Managing sedation, analgesia, delirium prevention, and neuroprotection in adult extracorporeal life support (ECLSO) patients presents significant professional challenges. These patients are critically ill, often hemodynamically unstable, and susceptible to neurological injury. Balancing the need for adequate comfort and immobility with the risks of over-sedation, under-sedation, and adverse drug effects requires constant vigilance and individualized care. Furthermore, the potential for delirium, a common and detrimental complication in critical care, necessitates proactive strategies. Ensuring optimal neurological outcomes while the patient is on life support adds another layer of complexity, demanding careful selection and monitoring of neuroprotective interventions. Correct Approach Analysis: The best professional practice involves a multimodal, individualized approach to sedation and analgesia, prioritizing patient comfort and minimizing iatrogenic harm. This includes utilizing validated assessment tools (e.g., RASS, CAM-ICU) to guide titration, employing a combination of continuous infusions and scheduled boluses of appropriate agents, and actively implementing non-pharmacological strategies for delirium prevention and management. Neuroprotection is integrated through minimizing cerebral hypoxia, maintaining adequate cerebral perfusion pressure, and judicious use of sedatives and analgesics that do not compromise neurological assessment or recovery. Adherence to institutional protocols, evidence-based guidelines, and continuous reassessment of the patient’s response are paramount. This approach aligns with ethical principles of beneficence and non-maleficence, ensuring the patient receives the best possible care while minimizing risks. Incorrect Approaches Analysis: Relying solely on continuous infusions of potent sedatives without regular reassessment or the use of validated scales is professionally unacceptable. This can lead to over-sedation, prolonged mechanical ventilation, increased risk of delirium, and difficulty in neurological assessment, violating the principle of individualized care and potentially causing harm. Administering analgesia and sedation only when the patient exhibits overt signs of distress, such as increased heart rate or blood pressure, without proactive assessment, can result in inadequate pain and anxiety management, leading to patient suffering and physiological stress. This fails to meet the ethical standard of providing comfort and dignity. Implementing aggressive pharmacological interventions for delirium without first addressing underlying physiological derangements or optimizing sedation and analgesia is also professionally unsound. This can exacerbate patient distress and lead to adverse drug reactions, neglecting the foundational elements of critical care management. Neglecting to monitor for signs of neurological compromise or failing to adjust sedation and analgesia based on neurological status directly contravenes the goal of neuroprotection and can lead to irreversible brain injury. Professional Reasoning: Professionals should adopt a systematic and patient-centered approach. This begins with a thorough assessment of the patient’s pain, anxiety, and potential for delirium, utilizing validated tools. Based on this assessment, an individualized sedation and analgesia plan should be developed, considering the patient’s underlying condition, hemodynamic stability, and potential for neurological injury. Regular reassessment of the patient’s comfort, level of sedation, and presence of delirium is crucial, with prompt adjustments to the treatment plan as needed. Non-pharmacological interventions for delirium prevention should be implemented proactively. Neuroprotective strategies should be integrated into the overall care plan, focusing on maintaining optimal physiological parameters. Continuous education and adherence to evidence-based guidelines are essential for ensuring the highest standard of care.

Scenario Analysis: This scenario presents a professional challenge in balancing immediate patient needs with the systematic improvement of care delivery. The integration of quality metrics, rapid response teams, and teleconsultation in advanced adult extracorporeal life support (ECLS) requires a nuanced approach that prioritizes patient safety and outcomes while also fostering a culture of continuous learning and system enhancement. The rapid evolution of ECLS technology and protocols, coupled with the critical nature of patients requiring these interventions, necessitates a robust framework for monitoring performance and responding effectively to deviations. The integration of remote expertise through teleconsultation adds another layer of complexity, requiring clear communication protocols and standardized data sharing. Correct Approach Analysis: The best professional practice involves a proactive and data-driven approach to quality improvement, directly linking observed performance metrics to the operational effectiveness of the rapid response system and the strategic deployment of teleconsultation resources. This approach prioritizes the systematic collection and analysis of ECLS-specific quality indicators (e.g., circuit survival rates, duration of support, complication rates, patient outcomes) and uses this data to inform the activation criteria and response protocols for the rapid response team. Furthermore, it leverages teleconsultation not just for acute crisis management but also for prospective case review and protocol refinement, ensuring that lessons learned from both successful and unsuccessful cases are integrated back into the system. This aligns with ethical principles of beneficence and non-maleficence by actively seeking to optimize patient care and minimize harm through evidence-based practice and continuous quality improvement. Regulatory frameworks often mandate such quality assurance processes to ensure patient safety and adherence to best practices in critical care. Incorrect Approaches Analysis: Relying solely on retrospective case reviews without a structured framework for immediate data capture and analysis fails to provide timely feedback for system adjustments, potentially delaying the identification and mitigation of systemic issues. This approach risks perpetuating suboptimal practices. Implementing teleconsultation only in response to critical events, without a strategy for its integration into routine quality monitoring or proactive case planning, misses opportunities to leverage remote expertise for early problem identification and preventative strategies. This reactive stance can lead to missed opportunities for learning and improvement. Focusing exclusively on the technical aspects of ECLS equipment maintenance and troubleshooting, while important, neglects the broader quality metrics related to patient outcomes, team performance, and the effectiveness of the rapid response and teleconsultation integration. This narrow focus can lead to a system that is technically sound but not optimally effective in delivering patient care. Professional Reasoning: Professionals should adopt a decision-making framework that begins with establishing clear, measurable quality metrics for ECLS. This data should then be used to define the triggers and scope of the rapid response team’s involvement, ensuring timely and appropriate intervention. Concurrently, teleconsultation should be strategically integrated, not only for emergent situations but also for educational purposes and prospective case review, fostering a collaborative learning environment. This integrated approach, grounded in data and continuous improvement, is essential for optimizing patient outcomes in complex ECLS scenarios.

Scenario Analysis: This scenario presents a professional challenge related to the integrity and fairness of an advanced competency assessment program. Ensuring that blueprint weighting, scoring, and retake policies are transparent, equitable, and consistently applied is crucial for maintaining the credibility of the assessment and the competence of the practitioners it evaluates. Professionals must navigate the tension between upholding assessment standards and providing reasonable opportunities for candidates to demonstrate their mastery, all within the established framework of the Advanced Adult Extracorporeal Life Support Competency Assessment. Careful judgment is required to balance these competing interests. Correct Approach Analysis: The best professional practice involves a thorough review of the existing assessment blueprint and its alignment with current clinical practice guidelines and the stated learning objectives of the Advanced Adult Extracorporeal Life Support Competency Assessment. This review should then inform a transparent revision of the blueprint weighting, ensuring it accurately reflects the relative importance of different knowledge and skill domains. Scoring methodologies should be clearly defined and consistently applied, with a robust, clearly communicated retake policy that offers candidates a fair opportunity to re-assess after remediation, without compromising the overall rigor of the assessment. This approach is correct because it prioritizes validity, reliability, and fairness in assessment, which are fundamental ethical and professional obligations in competency-based education and evaluation. Adherence to established assessment principles ensures that the assessment accurately measures the intended competencies and that candidates are evaluated equitably. Incorrect Approaches Analysis: One incorrect approach involves making arbitrary adjustments to the blueprint weighting based on anecdotal feedback from a small group of recent candidates, without a systematic review of clinical relevance or learning objectives. This fails to uphold the validity of the assessment, as weighting should be driven by objective criteria, not subjective opinions that may not reflect the full scope of essential knowledge and skills. Another incorrect approach is to implement a punitive retake policy that imposes excessive barriers or lengthy waiting periods without providing clear guidance on remediation, which can be ethically questionable by hindering professional development and potentially creating an unfair disadvantage for otherwise capable individuals. Finally, an approach that involves altering scoring criteria mid-assessment or inconsistently applying them to different candidates undermines the reliability and fairness of the evaluation, violating core principles of equitable assessment and professional integrity. Professional Reasoning: Professionals involved in competency assessment should adopt a systematic and evidence-based approach. This involves: 1) Understanding the assessment’s purpose and intended learning outcomes. 2) Regularly reviewing and validating the assessment blueprint against current professional standards and clinical practice. 3) Establishing clear, objective, and transparent scoring rubrics. 4) Developing a retake policy that balances rigor with fairness, including provisions for remediation and re-assessment. 5) Ensuring consistent application of all policies and procedures. This structured decision-making process ensures that assessments are valid, reliable, fair, and ethically sound, ultimately serving the best interests of both the candidates and the profession.

Scenario Analysis: This scenario is professionally challenging because it requires balancing immediate patient needs with the established protocols and the need for clear, documented communication among a multidisciplinary team. The pressure of a critical care environment can lead to rushed decisions and potential oversights, making adherence to best practices crucial for patient safety and team cohesion. Correct Approach Analysis: The best professional practice involves immediately initiating a structured handover to the receiving team, ensuring all critical information regarding the patient’s status, ongoing interventions, and immediate concerns is clearly and concisely communicated. This approach is correct because it aligns with established patient safety guidelines and professional ethical standards that mandate thorough and accurate communication during patient transfers. Specifically, it upholds the principle of continuity of care, ensuring the receiving team has all necessary information to manage the patient effectively without interruption or loss of critical data. This structured handover minimizes the risk of medical errors and ensures the patient’s care plan is seamlessly continued. Incorrect Approaches Analysis: One incorrect approach involves delaying the handover until the patient is fully stabilized and the immediate crisis has passed. This is professionally unacceptable as it creates a significant gap in care and communication, potentially leading to delays in further management or misinterpretation of the patient’s condition by the receiving team. It violates the principle of timely information transfer essential for patient safety. Another incorrect approach is to provide a verbal, unstructured update without any written documentation or confirmation of understanding. This is professionally unsound because it relies heavily on memory, increasing the risk of omissions or inaccuracies. Professional standards require clear, documented communication to ensure accountability and provide a reliable record of the patient’s status and care provided. A third incorrect approach is to assume the receiving team has full knowledge of the patient’s history and current situation, providing only a brief, high-level overview. This is professionally negligent as it fails to convey the critical details of the extracorporeal support, recent events, and specific management strategies. It demonstrates a lack of diligence and a failure to ensure the receiving team is adequately informed, jeopardizing patient care. Professional Reasoning: Professionals should employ a structured decision-making process that prioritizes patient safety and effective team communication. This involves anticipating the need for handover, preparing relevant information in advance, utilizing standardized communication tools (like SBAR or similar frameworks), and actively seeking confirmation of understanding from the receiving team. The process should also include a moment for reflection to ensure all critical aspects of care have been addressed and documented.

This scenario is professionally challenging because it requires balancing the urgency of advanced clinical training with the need for robust, evidence-based preparation to ensure patient safety and competency. The pressure to deploy skilled personnel quickly can lead to shortcuts, but the complexity of Extracorporeal Life Support (ECLS) demands a thorough and structured approach to learning. Careful judgment is required to ensure that candidate preparation is adequate without compromising the quality of training or patient care. The best professional practice involves a structured, multi-modal preparation strategy that integrates theoretical knowledge acquisition with practical skill development, guided by established competency frameworks and realistic timelines. This approach ensures that candidates not only understand the principles of ECLS but can also apply them safely and effectively in a clinical setting. It aligns with the ethical imperative to provide competent care and the professional responsibility to maintain high standards in specialized medical procedures. This approach typically includes dedicated study time for foundational knowledge, simulation-based training for procedural skills, and supervised clinical exposure, all mapped against defined learning objectives and competency milestones. An approach that relies solely on didactic lectures without practical simulation or clinical exposure is professionally unacceptable. This fails to address the psychomotor skills and critical decision-making required for ECLS, potentially leading to unsafe practice. It neglects the established best practices in medical education that emphasize hands-on experience and simulation for complex procedures. Another professionally unacceptable approach is to assume that prior experience in general critical care automatically translates to ECLS competency without specific, targeted preparation. This overlooks the unique complexities, equipment, and physiological considerations of ECLS, creating a significant risk of error and patient harm. It disregards the need for specialized training and assessment that is distinct from general critical care. A further professionally unacceptable approach is to rush the preparation timeline, prioritizing speed over thoroughness. This can lead to superficial learning, inadequate skill acquisition, and an inability to manage complications effectively. It undermines the principle of ensuring competence before independent practice and can have severe consequences for patient outcomes. Professionals should employ a decision-making framework that prioritizes patient safety above all else. This involves: 1) Identifying the specific competencies required for advanced ECLS practice, referencing relevant professional guidelines and institutional protocols. 2) Designing a comprehensive training program that includes theoretical learning, simulation, and supervised clinical experience, with clear learning objectives and assessment methods. 3) Establishing realistic timelines that allow for mastery of skills and knowledge, acknowledging that individual learning curves may vary. 4) Implementing robust assessment and feedback mechanisms to ensure candidates meet competency standards before progressing to independent practice. 5) Continuously evaluating and refining the preparation process based on feedback and outcomes.

This scenario presents a significant professional challenge due to the inherent emotional distress and vulnerability of families facing a loved one’s critical illness requiring extracorporeal life support (ECLS). The complexity arises from balancing the medical team’s expertise and the patient’s prognosis with the family’s understanding, values, and decision-making capacity. Ethical considerations are paramount, particularly regarding informed consent, truth-telling, and respecting patient autonomy, even when the patient cannot directly participate. The need for clear, empathetic, and culturally sensitive communication is crucial to foster trust and facilitate shared decision-making. The best professional approach involves a structured, empathetic, and transparent process of shared decision-making. This includes clearly and compassionately explaining the patient’s current condition, the rationale for ECLS, its potential benefits and risks, and the realistic prognosis, including the possibility of poor outcomes or prolonged recovery. It requires actively listening to the family’s concerns, values, and goals of care, and collaboratively developing a plan that aligns with these factors and the patient’s presumed wishes. This approach upholds the ethical principles of beneficence, non-maleficence, autonomy, and justice, and aligns with professional guidelines emphasizing patient-centered care and family engagement in critical care decisions. An approach that focuses solely on presenting ECLS as a definitive cure without adequately discussing potential complications, limitations, or the possibility of withdrawal of support is ethically deficient. It fails to provide a balanced and realistic picture, potentially leading to false hope and hindering genuine shared decision-making. This can violate the principle of truth-telling and undermine the family’s ability to make informed choices aligned with the patient’s best interests and their own values. Another unacceptable approach is to present ECLS as a last resort with minimal discussion of the patient’s prognosis or the ethical considerations surrounding prolonged treatment in the face of futility. This can lead to a reactive rather than proactive decision-making process, potentially prolonging suffering for both the patient and the family without a clear benefit. It neglects the professional responsibility to guide families through difficult prognostication and the ethical complexities of end-of-life care. Finally, an approach that prioritizes the medical team’s recommendations without sufficient engagement with the family’s values, beliefs, and goals of care is also professionally inadequate. While medical expertise is vital, ECLS decisions are deeply personal and require integration of the patient’s and family’s perspectives. Failing to do so can lead to decisions that are medically appropriate but emotionally and ethically misaligned with the family’s wishes, potentially causing significant distress and regret. Professionals should employ a decision-making framework that begins with establishing rapport and trust with the family. This involves active listening, empathetic communication, and a commitment to transparency. Prognostication should be presented honestly and compassionately, acknowledging uncertainties. Shared decision-making should be a collaborative process, where the medical team provides expert guidance, and the family, informed by that guidance and their own values, participates actively in choosing the best path forward, including considerations for goals of care and potential withdrawal of support.