共找到 20 条结果
Vaccination, a fundamental strategy for infectious disease prevention, presents unique challenges in individuals with altered immunity. These populations include individuals with inborn errors of immunity, autoimmune and inflammatory diseases, solid organ transplants, hematopoietic stem cell transplants, biologic and immunosuppressive therapies, and pregnancy. Despite concerns regarding variable vaccine responses, altered efficacy, and safety profiles, these groups remain under-represented in clinical trials. This review synthesizes current evidence on immunization outcomes in medically complex populations, highlighting strengths and limitations in existing research. We describe how altered immunity affects vaccine responses, summarize data on adverse reactions, and examine the influence of biologic therapies and pregnancy. Our analysis identifies significant gaps, including insufficient long-term durability data, inadequate safety surveillance for special populations, and limited incorporation of precision medicine approaches. We propose recommendations to address these deficiencies, including targeted vaccine trials for special populations, broader trial inclusion, enhanced outcome measures, refined safety monitoring, and tailored vaccine guidance. By advancing precision immunization strategies, clinicians and researchers can optimize vaccine protection for vulnerable groups, promoting equitable access and improving public health outcomes.
Neurodevelopmental and neurocognitive difficulties are prevalent among individuals with sickle cell disease and warrant prompt identification and support. This Special Report provides an executive summary of standards and recommendations for surveillance, screening, and evaluation for development and cognition across the lifespan developed by expert consensus through the National Alliance of Sickle Cell Centers. The development process, definitions, and overarching principles of the standards and recommendations are provided, as well as an accompanying algorithm and supplemental material to aid in implementation.
To support the development of the National Trauma Research Repository (NTRR), a multidisciplinary workgroup used a consensus-driven approach to review established epidemiologic data elements and recommend basic common data elements (CDEs) for inclusion in the NTRR data dictionary. A 10-member workgroup of military and civilian trauma researchers and data scientists located and reviewed databases, codebooks, data collection forms, and published articles for data elements relevant to trauma epidemiology. Identified data elements were reviewed in a three-round Delphi survey, and monthly meetings with the workgroup were conducted. Consensus during the Delphi survey was analyzed with an 80% agreement threshold. 13 sources were reviewed for epidemiology data elements. After the three survey rounds and workgroup discussions, 33 elements (80%) reached consensus for inclusion, 3 elements (7%) were excluded, and 5 elements (12%) did not reach consensus. The Delphi process proved effective in achieving expert consensus on basic CDEs for trauma epidemiologic research. The resulting standardized basic CDEs will improve data harmonization and support consistent data collection in the NTRR. These CDEs represent an initial framework and serve as a foundational starting point for epidemiological data collection within the NTRR. As researchers use the NTRR, the list of CDEs will grow and evolve with the needs of the trauma research community. CDE standardization not only supports interoperable research but also enhances research quality, efficiency, and translation into clinical practice. Level VII.
Postoperative spinal implant infection (PSII) is a clinically significant complication following spinal instrumentation, with diagnostic challenges related to biofilm formation and the lack of standardized criteria. This study aimed to investigate clinical, laboratory, and perioperative factors associated with PSII using a standardized spine-specific diagnostic framework proposed by the Musculoskeletal Infection Society (MSIS) European Bone and Joint Infection Society (EBJIS) workgroup. In this retrospective cohort study, 224 adult patients who underwent posterior spinal instrumentation surgery between January 2025 and January 2026 were included. Demographic characteristics, comorbidities, laboratory parameters, perioperative variables, and microbiological findings were obtained from electronic medical records. PSII was defined using a standardized spine-specific diagnostic framework proposed by the MSIS-EBJIS workgroup, integrating clinical, microbiological, and histopathological criteria. Variables with p < 0.10 in univariate analysis and strong clinical plausibility were considered for multivariate logistic regression. PSII developed in 18 patients (8.0%). No significant association was found between PSII and demographic variables or comorbidities. Elevated C-reactive protein (CRP) levels and lower serum albumin levels were associated with PSII (p < 0.05). In univariate analysis, American Society of Anesthesiologists (ASA) score ≥ 3, emergency surgery, perioperative steroid use, low molecular weight heparin use, postoperative prone recovery positioning, and intensive care unit admission were significantly associated with PSII. In multivariate analysis, only emergency surgery remained independently associated with PSII (OR: 6.48; 95% CI: 1.28-32.70; p = 0.024). PSII remains a clinically important complication following spinal instrumentation surgery. In this study, emergency surgery was the only variable independently associated with PSII; however, this finding should be interpreted cautiously given the limited number of events and wide confidence intervals. Elevated CRP levels and hypoalbuminemia were identified as associated findings rather than independent predictors. The use of structured spine-specific diagnostic frameworks based on the MSIS-EBJIS workgroup definition may improve consistency in PSII classification and enhance comparability across future studies. Larger prospective studies are needed to further clarify independent predictors and optimize preventive strategies. Emergency spinal instrumentation procedures may represent higher-risk clinical settings for PSII and may warrant enhanced perioperative infection prevention strategies and closer postoperative surveillance.
The scientific success of the Adolescent Brain Cognitive DevelopmentSM Study (ABCD®) rests on the data collection and analysis efforts of the staff and trainees within the Consortium. To support the critical work carried out by ABCD staff and trainees, the Professional Development Workgroup was launched in 2020 to offer resources and career guidance to better support the Consortium members comprising the backbone of the study. Here, the ABCD Professional Development Workgroup outlines key programming that has been offered to ABCD staff and trainees, including those instated before the official launch of ABCD data collection, and the addition of events throughout the years to meet the evolving needs of interested consortium members. We also discuss specific efforts to enhance a sense of community and facilitate communication among a large body of ABCD staff and trainees. We end with a discussion of challenges and proposed solutions that our Workgroup has encountered in leading professional development efforts, as well as future opportunities for further growth to nurture the next generation of scientists and professionals. As the number of large-scale datasets and multi-site collaborations grows across the globe, our hope is that the examples and lessons learned from professional development efforts in ABCD could be helpful for current or future scientific consortia.
Lupus nephritis (LN) remains a leading cause of morbidity and mortality in systemic lupus erythematosus, yet the lack of standardized definitions for renal outcomes hinders effective diagnosis, prognosis, treatment personalization, comparisons across trials, and interpretable trial endpoints. Despite significant advances in biomarker discovery, treatment strategies, and histopathological classification, substantial challenges and controversies persist in defining and assessing renal response to therapy. Following a January 2025 roundtable discussion on the subject of LN outcome definitions, a workgroup was established to address these issues and provide an expert perspective on the future of outcome definitions based on current literature. Here, we examine the current limitations of renal outcome definitions and advocate for change toward improved interpretation and comparison of clinical study data. Key areas, such as limitations of traditional kidney function markers and the need for reliable endpoints reflecting improvements in renal inflammation in trials, are addressed. As an international workgroup of rheumatologists and nephrologists with experience in managing LN, we advocate for a unified approach considering standard per-protocol repeat biopsies for histologic response evaluation, estimated glomerular filtration rate slope, glucocorticoid minimization/withdrawal, and extended follow-up for the evaluation of sustained long-term outcomes. The importance of harmonizing clinical and histologic definitions and the potential of novel biomarkers are highlighted. Herein, we provide a perspective toward uniform definitions of response in LN trials, renal flare/relapse, and refractory disease with improved applicability, especially in the context of advanced immunosuppressives. Thereby, we aim to facilitate meaningful study and advanced treatment of LN, ultimately enhancing patient outcomes and future research.
Scientific evidence regarding AKI and acute kidney care has advanced in recent years. However, a knowledge gap remains on the implementation of these evidence-based practices (EBPs) into clinical care. Implementation science (IS) is focused on ensuring that this knowledge is translated in an effective, efficient and sustainable fashion. 1) Define the current status of IS; 2) Define a roadmap for accelerating IS with a focus on patient/care partner advocacy, digital tool application, social determinants of health, and resource-limited settings; and 3) Develop a robust and broad research agenda incorporating IS methodology into the programs. ADQI XXXV was conducted through a modified Delphi process with virtual meetings preceding an in-person meeting. Five workgroups were determined a priori to focus on 1) IS definitions and methods applicable to AKI and acute kidney care; 2) IS literature in AKI and acute kidney care; 3) Innovations in IS to accelerate the adoption, adherence to, and sustainment of EBPs in AKI and acute kidney care; 4) IS methods in resource-limited settings; and 5) Recommendations to identify and evaluate EBPs that are ready for implementation or de-implementation. Prior to the in-person meeting, each workgroup met virtually to review the literature and develop framework questions to address their objectives. During the two-day in person meeting, through iterative discussions, questions and supporting statements were finalized. These questions and statements were agreed upon through voting to achieve consensus, defined as agreement of ≥80%. We report a structured multidisciplinary consensus for defining the role of IS in AKI and acute kidney care. Future programs should address these consensus questions and apply these statements along with IS methodology in the translation of science into clinical practice and the implementation/de-implementation of EBPs in clinical care.
Preexposure prophylaxis (PrEP) is highly effective for HIV prevention, yet cisgender women remain underrepresented among PrEP users relative to their HIV burden in the United States. Obstetrics and gynecology (OB/GYN) settings-where many women receive routine sexual and reproductive health care-represent a promising but underutilized venue for PrEP delivery. Despite professional guidance endorsing PrEP discussion and prescribing in OB/GYN practice, implementation remains limited. We conducted a qualitative implementation study with two linked components in an academic OB/GYN clinic: semistructured interviews with 12 clinicians and clinical staff, and four multidisciplinary stakeholder workgroups focused on strategy refinement. Interview transcripts were analyzed using directed content analysis guided by the Consolidated Framework for Implementation Research (CFIR 2.0). Finalized determinants were brought to stakeholder workgroups, where participants reviewed interview findings and collaboratively identified and prioritized implementation strategies. Strategies were labeled using Expert Recommendations for Implementing Change (ERIC) terminology. Five implementation determinants were identified: preventive care misfit within problem-focused visit structures, limited cognitive integration of PrEP into routine gynecologic care, fragmented care continuity and unclear role ownership, administrative and access burden, and lack of patient activation infrastructure. Stakeholders concluded that implementation failure reflected a workflow placement problem rather than a motivation problem. Strategies requiring clinicians to absorb additional counseling or coordination tasks during already time-limited visits were viewed as unlikely to succeed. Stakeholders instead refined a clinic-facing strategy bundle centered on nurse-led PrEP navigation, supported by EHR-embedded referral prompts, standardized handoff workflows, brief provider education and protocol clarification, pharmacy and insurance coordination partnerships, and structured tracking and follow-up systems. PrEP underimplementation in this gynecologic setting appeared to be driven less by clinician willingness than by the absence of a reliable workflow location for counseling, coordination, and follow-up. A nurse-led navigation model supported by referral prompts and access coordination may offer a feasible approach to integrating PrEP into women's health care. Future work should test this strategy bundle in multi-site women's health settings and pair clinic-facing approaches with patient-facing activation strategies.
A robust chain of survival is important for achieving positive outcomes following out-of-hospital cardiac arrest, which continues to pose a substantial public health challenge in Singapore. Although improvements have been made in prehospital resuscitation and survival to hospital admission, further progress is required for survival to hospital discharge and neurological recovery. This underscores the urgent need to strengthen post-cardiac arrest care-the sixth link in the chain of survival-to optimise outcomes for patients admitted to the intensive care unit after return of spontaneous circulation. This review builds on earlier recommendations of the National Targeted Temperature Management Workgroup (2017) and the National Post-Cardiac Arrest and Survivorship Workgroup (2021), providing an updated summary of post-cardiac arrest management and practical guidance for clinicians treating resuscitated cardiac arrest patients in the intensive care unit.
A comprehensive, competency-based epilepsy curriculum is needed to strengthen nurses' capacity to care for people with epilepsy worldwide. Such a curriculum should be adaptable across nursing roles, practice settings, and geographic regions. This report describes the development of a nursing curriculum for the International League Against Epilepsy (ILAE). The Curriculum Workgroup of the Nursing Section of the ILAE developed two educational levels: a core level essential for all nurses and a proficient level for nurses who regularly care for people with epilepsy. Each level comprises competencies across five domains: Role of the Nurse, Epilepsy Basics, Nursing Assessment, Nursing Care, and Self-Management Education and Care. Competencies were evaluated through an online survey assessing agreement using a five-point Likert scale. Competencies were accepted if ≥60% of respondents rated them as "extremely important." Items not meeting consensus were reviewed by the Nursing Workgroup and revised, merged, or rejected based on expert opinion. Overall, 55.8% of competencies met acceptance criteria by survey. Remaining competencies were refined through expert review to finalize the curriculum. More than 90% of respondents supported the curriculum, indicated they would use it in practice, and expressed interest in ILAE courses or programs based on the curriculum. This is the first competency-based epilepsy curriculum for nurses from an international epilepsy organization for worldwide use. It will form the basis of future online and in-person educational programs for nurses. The curriculum can be adapted to regional contexts worldwide, helping to address gaps in basic nursing education and continuing professional development.
Effective neonatal resuscitation demands coordinated teamwork following standardised algorithms and guidelines to ensure successful transition to extrauterine life. As guidelines evolve with emerging evidence, regular review and adherence to updated recommendations are crucial for optimal patient outcomes. We present the revised Singapore Neonatal Resuscitation Guidelines 2026. The recent 2025 recommendations from the International Liaison Committee on Resuscitation Neonatal Task Force's Consensus on Science and Treatment Recommendations, together with guidelines from the American Heart Association and the European Resuscitation Council, were compared with the existing guidelines. The recommendations of the Neonatal Subgroup of the Singapore Resuscitation and First Aid Council were formulated following the workgroup's critical discussion and appraisal of the currently available evidence, with careful consideration of its relevance and applicability to local clinical practice.
As extracorporeal membrane oxygenation (ECMO) utilization has increased and evolved over decades, much literature has focused on the technical and clinical aspects, with substantially less attention paid to the impact of ECMO support on patients, families, and clinicians. As part of the ECMO Ethics Workgroup project, this paper explores the experiential aspects and impacts of ECMO on clinicians, patients, and families. Review of available literature identifies substantial physical and psychological burdens associated with ECMO survivorship as well as psychosocial challenges for family members and medical decision makers. We also examine the impact of ECMO support on clinicians providing care. Though many challenging experiences associated with ECMO are potentially unavoidable consequences of care, we recognize an ethical imperative to improve our understanding of such challenging experiences and develop strategies to reduce or resolve them. As such, we review the current literature and provide recommendations based on our current understanding to improve the experiences of those impacted by ECMO. Our recommendations include guidance on clear and consistent decision-making frameworks, interdisciplinary communication, incorporation of patient values, and early ethics and palliative care consultation. Given the limited evidence, we also call for further research to support best practices in ECMO care, particularly regarding interdisciplinary communication, expert consultation, educational interventions for families, and systematic follow-up of survivors.
Immune checkpoint inhibitors (ICIs) have transformed cancer therapy but are associated with immune-related adverse events, including ICI-associated acute kidney injury (ICI-AKI). ICI-AKI presents diagnostic and management challenges and can influence decisions regarding immunosuppression and ICI rechallenge, with important implications for both kidney and cancer outcomes. An international, multidisciplinary panel convened at the 34th Acute Disease Quality Initiative (ADQI) consensus conference in September 2024. Systematic literature searches of PubMed were conducted to identify studies on the epidemiology, mechanisms, diagnosis, management, rechallenge, and outcomes of ICI-AKI. The meeting followed the established ADQI process and used a modified Delphi method to achieve consensus. Evidence was reviewed and appraised by workgroups, and consensus statements were developed through structured discussion and voting. Observational data suggest that AKI occurs in up to 20% of patients receiving ICIs, with ICI-AKI accounting for approximately 2%-5% of cases. Acute tubulointerstitial nephritis is the most common lesion, observed in 80%-90% of biopsies, although glomerular diseases are increasingly recognized. No clinical features reliably distinguish ICI-AKI from other causes of AKI, and kidney biopsy remains the diagnostic gold standard. Emerging urinary, circulating, and imaging biomarkers show promise but are not yet ready for routine clinical use. Early glucocorticoid initiation (within 3 days of ICI-AKI diagnosis versus >3 days after diagnosis) is associated with higher rates of kidney recovery, although optimal dosing and duration remain uncertain. Recurrent ICI-AKI occurs in fewer than 20% of patients undergoing ICI rechallenge. Management of high-risk populations, including kidney transplant recipients and patients with autoimmune disease or advanced CKD, requires individualized, multidisciplinary decision-making. ICI-AKI is an important and potentially reversible complication of cancer immunotherapy; these consensus statements provide a framework for diagnosis and management, support cautious ICI rechallenge in selected patients, and identify priorities for future research.
Competency-based medical education (CBME) focuses on the attainment of defined skills independent of the time spent in training. Emergency Medicine (EM) is starting the long process of CBME implementation. In preparation for the 2025 Society for Academic Emergency Medicine (SAEM) Consensus conference whose goal is to define the research agenda around CBME, a diverse workgroup of expert educators convened. They conducted a literature review and developed a large roster of potential research questions. Through a modified Delphi process, they prioritized 10 research questions related to CBME implementation. The final group of questions fell into three broad categories: (1) Program evaluation, (2) Change management, and (3) System needs and resources. Implementation of CBME in EM will require intentional incorporation of change management strategies and systematic development of program evaluation. This will minimize the risk of negative outcomes resulting from ineffective implementation strategies and promote the successful uptake of CBME within the specialty.
The growing body of evidence showing type 2 diabetes (T2D) as a potential risk factor for certain cancers supports the need to make cancer education a component of diabetes care efforts. This need is especially important for Indigenous populations who experience disproportionate high rates of T2D. The purpose of this article is to describe the development process of the health education curriculum and methods used to pilot the curriculum. The primary objective of the Ööqalat' Qa'tsit Yesni (Living a Strong Life) Curriculum is to increase participant knowledge of cancer and T2D, including recommended prevention, management, and early-\ detection practices. Guided by community-based participatory research principles and the Community Health Workers Praxis and Patient Health Behavior Framework, a tribal-university workgroup steered each stage of the project, including curriculum development, recruitment, evaluation strategies and dissemination plans. A purposeful sampling strategy will be used to recruit participants. Inclusion criteria include: having diagnosed T2D or pre-diabetes, and males and females between the ages of 18 to 75 years. A traditional pretest-post-test design will be used to assess participant knowledge. Results will be described in a future publication. The Ööqalat' Qa'tsit Yesni project is driven by a community-based participatory research tribal-university partnership. This collaborative design process resulted in a health education curriculum, which could contribute to community-engaged health promotion efforts in Indigenous communities.
Trauma remains one of the leading causes of death and disability in the USA, yet trauma research continues to suffer from inconsistent data collection standards, hindering data aggregation and interoperability. To advance trauma science and improve patient outcomes, the Department of Defense, in collaboration with the Coalition for National Trauma Research (CNTR), aimed to identify and implement a core set of common data elements (CDEs) for universal use in trauma research. A consensus-driven methodology guided by ACCORD reporting standards was employed. CNTR established a CDE Steering Committee comprising military, civilian, and academic trauma experts. Existing trauma and traumatic brain injury CDEs from the National Trauma Research Repository (NTRR) and the Federal Interagency Traumatic Brain Injury Research Informatics System were systematically compared, harmonized, and refined using informatics tools and expert feedback. The CDE Steering Committee met to evaluate 50 candidate data elements, with consensus defined as ≥80% agreement a priori. Nineteen committee members (9 in person, 10 virtually) participated in the survey. A final set of 10 core trauma CDEs was approved for inclusion in NTRR v2, categorized under demographics and injury characteristics. An additional 22 elements were referred to domain-specific workgroups for consideration in future basic CDE development. This process marks a critical step in improving trauma data harmonization. The adoption of these core trauma CDEs will support harmonization across trauma studies, enabling data reuse, pooled analysis, and cost-efficient trauma research. While consensus-based, this approach allows flexibility across study types but does not guarantee data harmonization. Successful implementation hinges on endorsement from funders and institutions. Future work includes developing therapeutic area-specific basic CDEs and promoting CDE adoption through training, technical support, and dissemination strategies. Not applicable (methods-focused study).
American Indian and Alaska Native (AI/AN) individuals remain profoundly underrepresented in surgical specialties. No national organization has historically focused on AI/AN surgeons. The Native American Surgical Society (NASS) was established through community-driven engagements at the 2023 and 2024 Association of American Indian Physicians (AAIP) annual meetings using culturally grounded methods, including talking circles and consensus-based workgroups. Participants spanned the surgical training continuum, representing 36 tribal affiliations and multiple specialties. Key outcomes included formal organizational establishment, development of mentorship infrastructure, and creation of national outreach initiatives. NASS represents the first Indigenous-led national effort to support AI/AN surgeons. Sustained progress will require investment in mentorship, infrastructure, and policy aligned with tribal sovereignty to improve representation and surgical equity.
Clinical and translational investigators increasingly rely on complex institutional and national data resources, yet barriers related to data discovery, governance, and access pathways remain common. To address fragmentation in data access, we piloted a Data Navigation Program within the Clinical and Translational Science Institute (CTSI) that established a trained Data Navigator as a centralized first point of contact for investigator data inquiries who provided individualized consultations, facilitated connections to data domain experts and honest broker services, and increased awareness of institutional data assets and regulatory requirements. To better characterize investigator needs, a CTSI-wide survey assessing data sources, governance, and training priorities was conducted in collaboration with the Clinical Translational Data Science (CTDS) Workgroup. Results demonstrated strong demand for structured guidance in data discovery and governance navigation. These findings informed refinement of the program, including development of the Research Data Source Match, a self-service decision-support tool implemented in REDCap that generates customized data access roadmaps based on investigator characteristics and data needs. During the pilot year, the Data Navigator conducted consultations addressing electronic health record (EHR), PCORnet resources, and government datasets. Integrating personalized navigation with scalable self-service tools may reduce barriers and support responsible data use in translational research.
Rehabilitation has been identified by the World Stroke Organization (WSO) as a key priority to reduce the global burden of stroke. Global access to rehabilitation is inconsistent and is particularly limited in low-and-middle-income countries. Progress in rehabilitation has not been as well evidenced as progress in acute care. The WSO certification program, which commenced in 2021, focuses on acute interventions. A rehabilitation certification program, applicable in both inpatient and outpatient rehabilitation settings, has been developed to complement the acute certification program to address global implementation of evidence-based stroke care. To develop globally applicable, evidence-based, stroke rehabilitation recommendations and performance metrics for use in a stroke rehabilitation certification program. Strong recommendations were extracted from high-quality stroke rehabilitation Clinical Practice Guidelines, systematic reviews and syntheses of clinical practice guidelines, and from the defining criteria of the International Stroke Recovery and Rehabilitation Alliance (ISRRA) Centers of Clinical Excellence. The WSO Rehabilitation Implementation Committee led the development of the recommendations and invited input from three international, multidisciplinary consultation groups. Group 1 compared strong recommendations from the Australia/New Zealand Living Guidelines with other international guidelines to identify consistent, high-quality recommendations. Group 2 mapped recommendations from global guideline syntheses against the Australia/New Zealand Living Guidelines. Group 3 reviewed and adapted the ISRRA Center of Clinical Excellence recommendations. Recommendations were consolidated through consensus meetings involving representatives from each workgroup, including people from high, upper-middle, and lower-middle-income countries. Strong recommendations that were consistent across teams, alongside additional recommendations based on certainty of evidence, anticipated risk versus benefit, and relevance across settings, were included as patient-level recommendations in the implementation certification program. Service-level recommendations were generated through consensus or derived from existing guidelines. An implementation manual, outlining "what," "who," and "how," as well as indicators to demonstrate performance of each recommendation, was developed to support clinical implementation and to facilitate assessment for certification. The criteria were piloted between November 2024 and September 2025 at 15 centers in six upper- and lower-middle-income countries (three continents) and subsequently refined. Expectations (mandatory or recommended) for each level of certification (Minimal, Essential and Advanced) were set post-pilot through rating strength of evidence, a series of group discussions and review of pilot data.ResultsFifty-five recommendations were included. Nine recommendations address service-level indicators, and 46 address patient-level indicators. Service-level indicators address defining features of rehabilitation services that are not apparent in individual patient medical record audits. Patient-level indicators address management of swallowing impairment, nutrition and hydration, information provision and goal setting, amount and timing of rehabilitation, exercise and motor rehabilitation, visual function, communication, mood and cognition, management of complications, and discharge planning and support. An implementation manual complements the recommendations to guide clinical care and consistent assessment.ConclusionsThe WSO rehabilitation recommendations and performance metrics incorporate the most current evidence and have been refined following pilot-testing. The recommendations are globally relevant and support both resource-limited and high-income settings in participating in the rehabilitation certification program to advance international stroke rehabilitation delivery.
Extracorporeal membrane oxygenation (ECMO) is a relatively novel, intensive medical intervention. It is known to raise important yet unsettled ethical concerns. We established the ECMO Ethics Workgroup in 2021 to improve our understanding of these ethical issues and their possible resolutions. This paper explains the methods used to produce our insights and recommendations, which additional papers from the project elaborate upon in detail. Initially, over six months, the 37 group members described the full range of ethical issues in ECMO care they were familiar with from experience, interpretation of relevant scholarship, and in response to our discussions. After we identified five major ethical themes and several sub-themes for analysis, the group restructured into smaller writing groups. Each group performed narrative and meta-narrative reviews targeting the themes of experiencing ECMO, starting ECMO, stopping ECMO, specialist consultants involved in ECMO care, and "other" themes. In addition to summarizing our insights and recommendations regarding four of these themes, this paper recommends revising the common conceptualization of ECMO therapy in terms of "bridges." To improve communication about ECMO care, we propose three categories of ECMO bridges, therapeutic, potentially therapeutic, and non-therapeutic, including the idea of "bridge to palliative care" in lieu of the concept of "bridge to nowhere."