Compassionate Deactivation of Pediatric Ventricular Assist Devices: A Review of 14 Cases.
J Pain Symptom Manage
; 62(3): 523-528, 2021 09.
Article
en En
| MEDLINE
| ID: mdl-33910026
ABSTRACT
CONTEXT Compassionate deactivation (CD) of ventricular assist device (VAD) support is a recognized option for children when the burden of therapy outweighs the benefits. OBJECTIVES:
To describe the prevalence, indications, and outcomes of CD of children supported by VADs at the end of life.METHODS:
Review of cases of CD at our institution between 2011 and 2020. To distinguish CD from other situations where VAD support is discontinued, patients were excluded from the study if they died during resuscitation (including extracorporeal membrane oxygenation), experienced brain or circulatory death prior to deactivation, or experienced a non-survivable brain injury likely to result in imminent death regardless of VAD status.RESULTS:
Of 24 deaths on VAD, 14 (58%) were CD. Median age was 5.7 (interquartile range (IQR) 0.6, 11.6) years; 6 (43%) had congenital heart disease; 4 (29%) were on a device that can be used outside of the hospital. CD occurred after 40 (IQR 26, 75) days of support; none while active transplant candidates. CD discussions were initiated by the caregiver in 6 (43%) cases, with the remainder initiated by a medical provider. Reasons for CD were multifactorial, including end-organ injury, infection, and stroke. CD occurred with endotracheal extubation and/or discontinuation of inotropes in 12 (86%) cases, and death occurred within 10 (IQR 4, 23) minutes of CD.CONCLUSION:
CD is the mode of death in more than half of our VAD non-survivors and is pursued for reasons primarily related to noncardiac events. Caregivers and providers both initiate CD discussions. Ventilatory and inotropic support is often withdrawn at time of CD with ensuing death.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Corazón Auxiliar
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Cardiopatías Congénitas
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Insuficiencia Cardíaca
Tipo de estudio:
Observational_studies
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Risk_factors_studies
Límite:
Child
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Child, preschool
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Humans
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Infant
Idioma:
En
Revista:
J Pain Symptom Manage
Asunto de la revista:
NEUROLOGIA
/
PSICOFISIOLOGIA
/
TERAPEUTICA
Año:
2021
Tipo del documento:
Article