Decision-Making, Ethics, and End-of-Life Care in Pediatric Extracorporeal Membrane Oxygenation: A Comprehensive Narrative Review. Issue 9 (2nd September 2021)

• Record Type: Journal Article
• Authors: Moynihan, Katie M.; Dorste, Anna; Siegel, Bryan D.; Rabinowitz, Edon J.; McReynolds, Andrew; October, Tessie W.
• Is Part Of: Pediatric critical care medicine. Volume 22:Issue 9(2021)
• Page Start: 806
• Page End: 812
• Publication Date: 2021-09-02
• Subjects: child -- communication -- decision-making -- ethics -- membrane oxygenation -- terminal care; Pediatric intensive care -- Periodicals; Pediatric emergencies -- Periodicals; 618.05
• DOI: 10.1097/PCC.0000000000002766
• Languages: English
• ISSNs: 1529-7535

Abstract

Abstract : Supplemental Digital Content is available in the text. 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.