A medical technology can keep people alive when they otherwise would have died. Where will it lead? By Clayton Dalton 
Every year, nearly four hundred thousand Americans suffer cardiac arrest outside of a hospital. Despite the use of CPR, defibrillators, and powerful drugs, fewer than one in ten survive. “That’s where ECMO comes in,” Jon Marinaro, an emergency physician and intensivist, told me. ECMO is a medical technology that can take over the work of the heart and lungs completely. Marinaro is using it for cardiac arrest, with about a thirty-per-cent survival rate. “If you were to triple survival with a cancer drug, people wouldn’t believe it,” he said. Robert Bartlett, who pioneered ECMO in the nineteen-sixties, envisions a future in which the technology could be used to create organ banks, revolutionizing organ transplant. “We could take out a liver that’s full of cancer, treat it, and then return it to the patient,” he told me. But, sometimes, patients who are put on ECMO don’t recover. They’re stuck in the I.C.U., on a bridge to nowhere. They can’t leave because they can’t live without the machine, and they can’t take it home with them. “It’s a trap,” the palliative and critical-care physician Jessica Zitter told me. “The technology is ahead of the ethics,” another expert said. My piece examines the tension between the promise and the peril of this technology. Will ECMO really create banks ready with living organs? Will it allow doctors to pop out a cancerous organ and overhaul it, like the transmission on a car? Or will it complicate life, when it inevitably begins to end? | .png)
