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

AbstractPurpose of ReviewTo 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 FindingsApproximately 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.SummaryA 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.
Source: Current Pediatrics Reports - Category: Pediatrics Source Type: research