Deactivation of Ventricular Assist Devices: Perspectives and Experiences of Adult Cardiovascular Providers

Blume, Elizabeth D.; Hauptman, Paul J.; Cooper, Stephanie; Goodlin, Sarah J.; Swetz, Keith M.; Alpert, Craig; Hummel, Scott L.; Doherty, Caroline; Salazar, Jorge Brenes; Maurer, Mathew S.; Cestoni, Abby; Bohannon, Kelli; Light-McGroary, Kelly Ann; Kirkpatrick, James N.

doi:10.1016/j.cardfail.2017.04.008

Cited by 8 publications

(16 citation statements)

References 5 publications

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“…The main finding of this survey is that while almost all respondents “Agreed” that pediatric VAD deactivation is sometimes necessary to relieve suffering, there is no consensus among respondents regarding specific indications for deactivation, other than “intractable suffering” or severe neurologic injury related to stroke. This conclusion is similar to a comparable survey of adult heart failure practitioners from the American College of Cardiology . VAD withdrawal in adults is considered acceptable and appropriate in many circumstances; however, opinions and practice patterns vary, despite widespread use .…”

Section: Discussionsupporting

confidence: 80%

“…This conclusion is similar to a comparable survey of adult heart failure practitioners from the American College of Cardiology . VAD withdrawal in adults is considered acceptable and appropriate in many circumstances; however, opinions and practice patterns vary, despite widespread use . In a survey of European Heart Failure Society members on the same topic, 30% of respondents reported that an adult patient's request for his/her own VAD deactivation should never be honored, illustrating regional diversity related to patient autonomy .…”

Section: Discussionsupporting

confidence: 74%

“…A 64‐item survey was developed mainly consisting of closed‐ended questions with categorical answer choices or Likert scales (Appendix S1). Some questions were adapted (with permission) from the related surveys of VAD withdrawal in adults . The survey was piloted by an advisory group of eight pediatric CICU and heart failure physicians at a single institution for input and modification with excellent internal consistency (alpha = 0.9).…”

Section: Methodsmentioning

confidence: 99%

“…Despite widespread VAD usage as DT in adults, opinions and level of comfort with compassionate VAD deactivation vary . With respect to children, there are additional considerations regarding withdrawal of life‐sustaining therapies that are distinct from adults.…”

Section: Introductionmentioning

confidence: 99%

“…4,5 Despite widespread VAD usage as DT in adults, opinions and level of comfort with compassionate VAD deactivation vary. [6][7][8] With respect to children, there are additional considerations regarding withdrawal of life-sustaining therapies that are distinct from adults. Whereas withdrawal of life support in children has been extensively explored in oncology, neonatology, and pediatric critical care, the attitudes and practices of pediatric clinicians regarding compassionate VAD deactivation for pediatric patients have not been studied and may be distinct from these other clinical scenarios.…”

Section: Introductionmentioning

confidence: 99%

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Compassionate deactivation of ventricular assist devices in children: A survey of pediatric ventricular assist device clinicians’ perspectives and practices

Kaufman

Hollander

Zhang

et al. 2019

Pediatric Transplantation

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Objectives This study's objective was to investigate compassionate ventricular assist device deactivation (VADdeact) in children from the perspective of the pediatric heart failure provider. Background Pediatric VAD use is a standard therapy for advanced heart failure. Serious adverse events may affect relative benefit of continued support, leading to consideration of VADdeact. Perspectives and practices regarding VADdeact have been studied in adults but not in children. Methods A web‐based anonymous survey of clinicians for pediatric VAD patients (<18 years) was sent to list‐serves for the ISHLT Pediatric Council, the International Consortium of Circulatory Assist Clinicians Pediatric Taskforce, and the Pediatric Cardiac Intensivist Society. Results A total of 106 respondents met inclusion criteria of caring for pediatric VAD patients. Annual VAD volume per clinician ranged from <4 (33%) to >9 (20%). Seventy percent of respondents had performed VADdeact of a child. Response varied to VADdeact requests by parent or patient and was influenced by professional degree and region of practice. Except for the scenario of intractable suffering, no consensus on VADdeact appropriateness was reported. Age of child thought capable of making informed requests for VADdeact varied by subspecialty. The majority of respondents (62%) do not feel fully informed of relevant legal issues; 84% reported that professional society supported guidelines for VADdeact in children had utility. Conclusion There is limited consensus regarding indications for VADdeact in children reported by pediatric VAD provider survey respondents. Knowledge gaps related to legal issues are evident; therefore, professional guidelines and educational resources related to pediatric VADdeact are needed.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionsupporting

confidence: 74%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Compassionate deactivation of ventricular assist devices in children: A survey of pediatric ventricular assist device clinicians’ perspectives and practices

Kaufman

Hollander

Zhang

et al. 2019

Pediatric Transplantation

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Palliative Care for Patients on Mechanical Circulatory Support

Wordingham¹,

McIlvennan

2019

AMA Journal of Ethics

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Palliative care (PC) teams are primed to support patients with advanced illness, including patients with mechanical circulatory support (MCS), and are increasingly being called upon to help care for these patients. Detailed guidelines for PC engagement are lacking despite key stakeholders' endorsements of collaboration. PC needs to encompass the decision-making period, the duration of therapy, and end-of-life care. PC teams can assist with symptom management, advance care planning, and communication across the continuum of MCS care. However, the current state of MCS and PC collaboration is variable and can be hindered by staffing challenges and clinician discomfort. To best care for patients who receive advanced cardiopulmonary life-sustaining therapies, meaningful engagement of PC during all phases of MCS is essential. Need for Palliative Care Partnerships Mechanical circulatory support (MCS) is increasingly being used to support patients with advanced heart failure. 1 In many tertiary hospitals, once foreign devices are now common, including left ventricular assist devices (LVAD), extracorporeal membrane oxygenation (ECMO), and total artificial hearts. 1 Initially developed and used as a bridge to other treatment options such as transplantation, advanced heart failure therapies now support patients with diverse goals of care and for variable periods of time, ranging from hours to years. For patients who ultimately progress to end of life with their device in situ or suffer from complications, issues concerning quality of life, mortality, psychosocial needs, and advance care planning can be complex. Palliative care (PC) teams are well equipped to support patients, families, and MCS teams throughout the continuum of MCS care.

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Psychosocial and Palliative Aspects of VAD Care

Abshire

Nakagawa²

2022

A Guide to Mechanical Circulatory Support

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Deactivation of Ventricular Assist Devices: Perspectives and Experiences of Adult Cardiovascular Providers

Cited by 8 publications

References 5 publications

Compassionate deactivation of ventricular assist devices in children: A survey of pediatric ventricular assist device clinicians’ perspectives and practices

Compassionate deactivation of ventricular assist devices in children: A survey of pediatric ventricular assist device clinicians’ perspectives and practices

Palliative Care for Patients on Mechanical Circulatory Support

Psychosocial and Palliative Aspects of VAD Care

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