Extracorporeal Membrane Oxygenation for Pediatric Patients With Coronavirus Disease 2019-Related Illness.

OBJECTIVE: To describe current hospital guidelines and the opinions of extracorporeal membrane oxygenation leaders at U.S. children's hospitals concerning the use of extracorporeal membrane oxygenation for coronavirus disease 2019-positive pediatric patients. DESIGN: Confidential, self-administered questionnaire. SETTING: One hundred twenty-seven U.S. pediatric extracorporeal membrane oxygenation centers. SUBJECTS: Extracorporeal membrane oxygenation center program directors and coordinators. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: In March 2020, a survey was sent to 127 pediatric extracorporeal membrane oxygenation centers asking them to report their current hospital extracorporeal membrane oxygenation guidelines for coronavirus disease 2019-positive patients. Respondents were also asked their opinion on three ethical dilemmas including: prioritization of children over adults for extracorporeal membrane oxygenation use, institution of do-not-resuscitate orders, and the use of extracorporeal cardiopulmonary resuscitation for coronavirus disease 2019-positive patients. Forty-seven extracorporeal membrane oxygenation centers had enacted guidelines including 46 (100%) that offer venovenous-extracorporeal membrane oxygenation and 42 (89%) that offer venoarterial-extracorporeal membrane oxygenation for coronavirus disease 2019-positive pediatric patients. Forty-four centers (94%) stated that the indications for extracorporeal membrane oxygenation candidacy in coronavirus disease 2019 disease were similar to those used in other viral illnesses, such as respiratory syncytial virus or influenza. Most program directors (98%) did not endorse that children hospitalized with coronavirus disease 2019 should be made do-not-resuscitate and had variable opinions on whether children should be given higher priority over adults when rationing extracorporeal membrane oxygenation. Over half of program directors (60%) did not support the use of extracorporeal cardiopulmonary resuscitation for coronavirus disease 2019. CONCLUSIONS: The majority of pediatric extracorporeal membrane oxygenation centers have proactively established guidelines for the use of extracorporeal membrane oxygenation for coronavirus disease 2019-related illnesses. Further work is needed to help guide the fair allocation of extracorporeal membrane oxygenation resources and to determine the appropriateness of extracorporeal cardiopulmonary resuscitation.

Bioética en donación y trasplante de órganos / Bioethics in donation and organ transplants / Bioètica en donació i trasplantament d'òrgans

Los intensivistas constituyen la columna vertebral del modelo español de donación y trasplantes. En el proceso de información a familiares en la donación en asistolia no controlada hay que respetar la autonomía, no hacer maleficencia y velar por la justicia. Este procedimiento solo se activará una vez que todas las opciones de tratamientos posibles, incluida la E-CPR donde se disponga de ella, se hayan descartado por no indicación o se hayan demostrado inútiles. El uso de catéter para bloqueo aórtico con monitorización de presión arterial radial izquierda evita el problema ético de la reanimación indeseada en la donación en asistolia controlada, al garantizar que la circulación al corazón y al cerebro no se restaure después del inicio de la ECMO tras el fallecimiento. Los intensivistas deben recordar que, para los profesionales que atienden a pacientes en los escenarios del final de la vida, ofrecer la opción de la donación de órganos y tejidos, es una obligación para respetar la autonomía de nuestros pacientes

The intensivists constitute the cornerstone of the Spanish model of donation and transplants. In the process of informing relatives in uncontrolled donation after circulatory death, autonomy must be respected, not maleficence and justice must be observed. This procedure will only be activated once all possible treatment options, including E-CPR where available, have been ruled out due to non-indication or futility. The use of a catheter for an aortic block with left radial blood pressure monitoring avoids the ethical problem of unwanted resuscitation in controlled donation after circulatory death, by ensuring that circulation to the heart and brain is not restored after the onset of ECMO after the death. Intensivists should remember that, for professionals who care for patients in end-of-life scenarios, offering the option of organ and tissue donation is an obligation to respect the autonomy of our patients

Els intensivistes constitueixen la columna vertebral del model espanyol de donació I trasplantaments. En el procés d'informació als familiars en la donació en assistòlia no controlada cal respectar l'autonomia, no fer maleficència I vetllar per la justícia. Aquest procediment solament s'ha d'activar una cop totes les opcions de tractaments possibles, inclosa l'E-CPR on es disposi d'ella, s'hagin descartat, bé per no indicació o bé perquè s'hagin demostrat inútils. L'ús de catèter per a bloqueig aòrtic amb monitoratge de pressió arterial radial esquerra evita el problema ètic de la reanimació indesitjada en la donació en assistòlia controlada, en garantir que la circulació al cor I al cervell no es restauri després de l'inici de la ECMO post- defunció. Els intensivistes han de recordar que per als professionals que atenen pacients en els escenaris del final de la vida oferir l'opció de la donació d'òrgans I teixits, és una obligació a fi de respectar l'autonomia dels nostres pacients