Providing Compassionate End of Life Care in the Setting of Mechanical Circulatory Support

Anna Joong*, Sabrina Fraser Derrington, Angira Patel, Philip T. Thrush, Kiona Yasmin Allen, Bradley Scott Marino

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations

Abstract

Purpose of Review: To outline key elements in providing compassionate end-of-life care for pediatric patients with end-stage heart failure on mechanical circulatory support (MCS) such as extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VADs). Recent Findings: Approximately one in five pediatric patients with end-stage heart failure die on VAD support, with higher mortality associated with patients supported on ECMO. While it is considered ethically and legally permissible to withdraw MCS, pediatric-specific guidelines regarding indications and end-of-life management on MCS are lacking. Summary: A multidisciplinary approach with early consultation of the palliative care team is essential for all patients being considered for MCS. Guiding families through end-of-life care on MCS requires frequent and honest communication by engaging in shared decision-making regarding prognosis and potential clinical pathways, advanced care and preparedness planning, and identifying and meeting patients’/families’ goals of care.

Original languageEnglish (US)
Pages (from-to)168-175
Number of pages8
JournalCurrent Pediatrics Reports
Volume7
Issue number4
DOIs
StatePublished - Dec 2019

Keywords

  • Extracorporeal mechanical support
  • Palliative care
  • Pediatric cardiology
  • Ventricular assist device

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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