Decision-Making, Ethics, and End-of-Life Care in Pediatric Extracorporeal Membrane Oxygenation: A Comprehensive Narrative Review

Katie M. Moynihan, Anna Dorste, Bryan D. Siegel, Edon J. Rabinowitz, Andrew McReynolds, Tessie W. October

Research output: Contribution to journalReview articlepeer-review

7 Scopus citations

Abstract

Objectives: Pediatric extracorporeal membrane oxygenation is associated with significant morbidity and mortality. We sought to summarize literature on communication and decision-making, end-of-life care, and ethical issues to identify recommended approaches and highlight knowledge gaps. Data Sources: PubMed, Embase, Web of Science, and Cochrane Library. Study Selection: We reviewed published articles (1972-2020) which examined three pediatric extracorporeal membrane oxygenation domains: 1) decision-making or communication between clinicians and patients/families, 2) ethical issues, or 3) end-of-life care. Data Extraction: Two reviewers independently assessed eligibility using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. Data Synthesis: Of 2,581 publications screened, we identified one systematic review and 35 descriptive studies. No practical guides exist for communication and decision-making in pediatric extracorporeal membrane oxygenation. Conversation principles and parent/clinician perspectives are described. Ethical issues related to consent, initiation, discontinuation, resource allocation, and research. No patient-level synthesis of ethical issues or end-of-life care in pediatric extracorporeal membrane oxygenation was identified. Conclusions: Despite numerous ethical issues reported surrounding pediatric extracorporeal membrane oxygenation, we found limited patient-level research and no practical guides for communicating with families or managing extracorporeal membrane oxygenation discontinuation.

Original languageEnglish
Pages (from-to)806-812
Number of pages7
JournalPediatric Critical Care Medicine
DOIs
StateAccepted/In press - 2021

Keywords

  • child
  • communication
  • decision-making
  • ethics
  • membrane oxygenation
  • terminal care

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