Abstract
Context
Little is known about the real-time decision-making process of patients with capacity
to choose withdrawal of temporary mechanical circulatory support (MCS).
Objectives
To assess how withdrawal of temporary MCS occurs when patients possess the capacity
to make this decision themselves.
Methods
This retrospective case series included adults supported by CentriMag Acute Circulatory
Support or Veno-Arterial Extracorporeal Membrane Oxygenation from February 2, 2007
to May 27, 2020 at a tertiary academic medical center who possessed capacity to participate
in end-of-life discussions. Authors performed chart review to determine times between
“initiation of temporary MCS,” “determination of ‘bridge to nowhere,’” “patient expressing
desire to withdraw,” “agreement to withdraw,” “withdrawal,” and “death,” as well as
reasons for withdrawal and the role of ethics, psychiatry, and palliative care.
Results
A total of 796 individuals were included. MCS was withdrawn in 178 (22.4%) of cases.
Six of these 178 patients (3.4%) possessed the capacity to decide to withdraw MCS.
Time between “patient expressing desire to withdraw” and “agreement to withdraw” ranged
from 0 to 3 days; time between “agreement to withdraw” and “withdrawal” ranged from
0 to 6 days. Common reasons for withdrawal include perceived decline in quality of
life or low probability of recovery. Ethics and psychiatry were consulted in 3 of
6 cases and palliative care in 5 of 6 cases.
Conclusion
While it is rare for patients on MCS to request withdrawal, such cases provide insight
into reasons for withdrawal and the important roles of multidisciplinary teams in
helping patients and families through end-of-life decision-making.
Abbreviations:
MCS (mechanical circulatory support), VA-ECMO (veno-arterial extracorporeal membrane oxygenation), STVAD (short-term ventricular assist device), LVAD (left ventricular assist device), OHT (orthotopic heart transplant), ICU (intensive care unit)Key Words
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Article info
Publication history
Published online: October 21, 2021
Accepted:
October 15,
2021
Identification
Copyright
© 2021 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
