Features| February 2022 When a Devastating Event Occurs: Ethical Analysis of a Clinically Challenging Case Rachel Hadler, MD; Rachel Hadler, MD Search for other works by this author on: This Site PubMed Google Scholar Shahla Siddiqui, MD, MS, D.ABA, FCCM Shahla Siddiqui, MD, MS, D.ABA, FCCM Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor February 2022, Vol. 86, 27–28. https://doi.org/10.1097/01.ASM.0000820416.05238.1d Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share MailTo Twitter LinkedIn Cite Icon Cite Get Permissions Search Site Citation Rachel Hadler, Shahla Siddiqui; When a Devastating Event Occurs: Ethical Analysis of a Clinically Challenging Case. ASA Monitor 2022; 86:27–28 doi: https://doi.org/10.1097/01.ASM.0000820416.05238.1d Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: ethical analysis, ethics Case: A 65-year-old man with a previous medical history of hypertension, hyperlipidemia, and obesity is diagnosed with renal cell carcinoma with associated inferior vena cava (IVC) thrombus and concern for pulmonary metastases. He presents to the OR for nephrectomy and IVC thrombectomy. His intraoperative course is complicated by bleeding and subsequently profound hypoxia and hypotension concerning for pulmonary embolus (PE). Intraoperative transesophageal echocardiogram corroborates the diagnosis of PE. The surgical team proposes initiation of extracorporeal membrane oxygenation (ECMO) and cannulates the patient. Following heparinization, he becomes profoundly coagulopathic, requiring massive transfusion. Postoperatively, he is transferred to the ICU, persistently coagulopathic with ongoing transfusion requirements. He later undergoes a CT angiogram notable for extensive bilateral PEs. He is taken for suction thrombectomy, which is unsuccessful. He remains in the ICU, now with evidence of multisystem organ dysfunction, requiring high levels of oxygen, hemodynamic, and extracorporeal support. In the preoperative period, future... You do not currently have access to this content.