Compassionate Deactivation of Pediatric Ventricular Assist Devices: A Review of 14 Cases

Title

Compassionate Deactivation of Pediatric Ventricular Assist Devices: A Review of 14 Cases

Creator

Hollander SA; Kaufman BD; Bui C; Gregori B; Murray JM; Sacks L; Ryan KR; Ma M; Rosenthal DN; Char D

Publisher

Journal of Pain and Symptom Management

Date

2021

Subject

pediatric; end-of-life; palliative; heart failure; compassionate deactivation; ventricular assist

Description

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 2011-2020. To distinguish CD from other situations where VAD support is discontinued, patients were excluded from the study if they died during resuscitation (including ECMO), 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 (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. CONCLUSIONS: 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 Ventilatory and inotropic support is often withdrawn at time of CD with ensuing death.

Rights

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Citation List Month

June 2021 List

Collection

Citation

Hollander SA; Kaufman BD; Bui C; Gregori B; Murray JM; Sacks L; Ryan KR; Ma M; Rosenthal DN; Char D, “Compassionate Deactivation of Pediatric Ventricular Assist Devices: A Review of 14 Cases,” Pediatric Palliative Care Library, accessed August 3, 2021, https://pedpalascnetlibrary.omeka.net/items/show/17571.

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