Population Characteristics and Markers for Withdrawal of Life-Sustaining Therapy in Patients on Extracorporeal Membrane Oxygenation

Carlson, Julia M.; Etchill, Eric W.; Enriquez, Clare Angeli G.; Peeler, Anna; Whitman, Glenn; Choi, Chun Woo; Geocadin, Romergryko G.; Cho, Sung Min

doi:10.1053/j.jvca.2021.04.040

Cited by 13 publications

(17 citation statements)

References 27 publications

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“…19 This corroborates the underutilization of PC services in ECMO patients who died after WLST seen in previous studies. 15,19…”

Section: Discussionsupporting

confidence: 89%

“…This suggests that among patients in this study who did not receive PC, there was ample opportunity for PC consultation before WLST. 19 This corroborates the underutilization of PC services in ECMO patients who died after WLST seen in previous studies. 15,19 Third, there were very few patient characteristics associated with PC consultation.…”

Section: Discussionsupporting

confidence: 89%

“…32 Two additional studies analyzed PC utilization in patients on ECMO for whom WLST was requested. 15,19 Although these studies are useful in the context of patients who die while on ECMO, they focus on a subset of patients requiring ECMO support and fail to illustrate PC's utility in patients who are expected to survive. Finally, one study described PC utilization in patients on ECMO as a result of complications from COVID-19.…”

Section: Discussionmentioning

confidence: 99%

“…2,16 Although the expansion of PC services for patients requiring ECMO support has been called for multiple times, there is a paucity of data describing PC utilization in this population. [17][18][19][20][21] We aimed to describe the prevalence of and identify patientlevel factors associated with PC consultation in adult patients requiring ECMO support at a single tertiary academic hospital.…”

mentioning

confidence: 99%

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Palliative Care Utilization in Patients Requiring Extracorporeal Membrane Oxygenation: An Observational Study

Peeler,

Davidson,

Gleason

et al. 2023

ASAIO Journal

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Palliative care (PC) is a model of care centered around improving the quality of life for individuals with life-limiting illnesses. Few studies have examined its impact in patients on extracorporeal membrane oxygenation (ECMO). We aimed to describe demographics, clinical characteristics, and complications associated with PC consultation in adult patients requiring ECMO support. We analyzed data from an ECMO registry, including patients aged 18 years and older who have received either venoarterial (VA)- or venovenous (VV)-ECMO support between July 2016 and September 2021. We used analysis of variance and Fisher exact tests to identify factors associated with PC consultation. Of 256, 177 patients (69.1%) received VA-ECMO support and 79 (30.9%) received VV-ECMO support. Overall, 115 patients (44.9%) received PC consultation while on ECMO. Patients receiving PC consultation were more likely to be non-white (47% vs. 53%, p = 0.016), have an attending physician from a medical versus surgical specialty (65.3% vs. 39.6%), have VV-ECMO (77.2% vs. 30.5%, p < 0.001), and have longer ECMO duration (6.2 vs. 23.0, p < 0.001). Patients were seen by the PC team on an average of 7.6 times (range, 1–35), with those who died having significantly more visits (11.2 vs. 5.6, p < 0.001) despite the shorter hospital stay. The average time from cannulation to the first PC visit was 5.3 ± 5 days. Congestive heart failure in VA-ECMO, coronavirus disease 2019 infection in VV-ECMO, and non-white race and longer ECMO duration for all patients were associated with PC consultation. We found that despite the benefits of PC, it is underused in this population.

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“…19 This corroborates the underutilization of PC services in ECMO patients who died after WLST seen in previous studies. 15,19…”

Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Palliative Care Utilization in Patients Requiring Extracorporeal Membrane Oxygenation: An Observational Study

Peeler,

Davidson,

Gleason

et al. 2023

ASAIO Journal

Self Cite

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“…Current standards suggest three to four days are sufficient, though there are reported durations up to eight days [ 15 , 46 ]. Consensus should be developed based on parameters that can drive futility determinations, including validated markers of multiorgan failure or monitoring to determine extent of neurological injury [ 47 ]. Consistency and transparency are critical for public trust and fair utilization of scarce resources.…”

Section: Considerations In Uncertainty Of Ecpr Outcomesmentioning

confidence: 99%

Extracorporeal cardiopulmonary resuscitation dissemination and integration with organ preservation in the USA: ethical and logistical considerations

et al. 2023

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Use of extracorporeal membrane oxygenation (ECMO) in cardiopulmonary resuscitation, termed eCPR, offers the prospect of improving survival with good neurological function after cardiac arrest. After death, ECMO can also be used for enhanced preservation of abdominal and thoracic organs, designated normothermic regional perfusion (NRP), before organ recovery for transplantation. To optimize resuscitation and transplantation outcomes, healthcare networks in Portugal and Italy have developed cardiac arrest protocols that integrate use of eCPR with NRP. Similar dissemination of eCPR and its integration with NRP in the USA raise novel ethical issues due to a non-nationalized health system and an opt-in framework for organ donation, as well as other legal and cultural factors. Nonetheless, eCPR investigations are ongoing, and both eCPR and NRP are selectively employed in clinical practice. This paper delineates the most pressing relevant ethical considerations and proposes recommendations for implementation of protocols that aim to promote public trust and reduce conflicts of interest. Transparent policies should rely on protocols that separate lifesaving from organ preservation considerations; robust, centralized eCPR data to inform equitable and evidence-based allocations; uniform practices concerning clinical decision-making and resource utilization; and partnership with community stakeholders, allowing patients to make decisions about emergency care that align with their values. Proactively addressing these ethical and logistical challenges could enable eCPR dissemination and integration with NRP protocols in the USA, with the potential to maximize lives saved through both improved resuscitation with good neurological outcomes and increased organ donation opportunities when resuscitation is unsuccessful or not in accordance with individuals’ wishes.

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The state of emergency department extracorporeal cardiopulmonary resuscitation: Where are we now, and where are we going?

Ciullo,

Tonna

2024

JACEP Open

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Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged in the context of the emergency department as a life‐saving therapy for patients with refractory cardiac arrest. This review examines the utility of ECPR based on current evidence gleaned from three pivotal trials: the ARREST trial, the Prague study, and the INCEPTION trial. We also discuss several considerations in the care of these complex patients, including prehospital strategy, patient selection, and postcardiac arrest management. Collectively, the evidence from these trials emphasizes the growing significance of ECPR as a viable intervention, highlighting its potential for improved outcomes and survival rates in patients with refractory cardiac arrest when employed judiciously. As such, these findings advocate the need for further research and protocol development to optimize its use in diverse clinical scenarios.

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Population Characteristics and Markers for Withdrawal of Life-Sustaining Therapy in Patients on Extracorporeal Membrane Oxygenation

Cited by 13 publications

References 27 publications

Palliative Care Utilization in Patients Requiring Extracorporeal Membrane Oxygenation: An Observational Study

Palliative Care Utilization in Patients Requiring Extracorporeal Membrane Oxygenation: An Observational Study

Extracorporeal cardiopulmonary resuscitation dissemination and integration with organ preservation in the USA: ethical and logistical considerations

The state of emergency department extracorporeal cardiopulmonary resuscitation: Where are we now, and where are we going?

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