Is informed consent for extracorporeal life support even possible?

Extracorporeal membrane oxygenation (ECMO), the most common form of extracorporeal life support (ECLS) technology, is an increasingly common way of providing life support to patients in severe cardiac or respiratory failure. In the vast majority of instances, informed consent, as it is commonly understood, cannot be obtained from either the patient or a proxy agent. The obstacles to obtaining informed consent are multiple and include the following: informed consent cannot be obtained from a patient who is unconscious; time pressure prevents the obtaining of informed consent from a patient with severe respiratory failure and dyspnea; and, in almost all cases involving ECLS, time pressure precludes the kind of education and conversation that are integral to the informed consent process.