Compassionate deactivation of ventricular assist devices in children: A survey of pediatric ventricular assist device clinicians' perspectives and practices.

Autor: Kaufman BD; Department of Pediatrics, Stanford University School of Medicine, Stanford, California., Hollander SA; Department of Pediatrics, Stanford University School of Medicine, Stanford, California., Zhang Y; Department of Pediatrics, Stanford University School of Medicine, Stanford, California., Chen S; Department of Pediatrics, Stanford University School of Medicine, Stanford, California., Bernstein D; Department of Pediatrics, Stanford University School of Medicine, Stanford, California., Rosenthal DN; Department of Pediatrics, Stanford University School of Medicine, Stanford, California., Almond CS; Department of Pediatrics, Stanford University School of Medicine, Stanford, California., Murray JM; Department of Pediatrics, Stanford University School of Medicine, Stanford, California., Burgart AM; Anesthesiology, Perioperative and Pain Medicine, Stanford Center for Biomedical Ethics, Stanford University, Palo Alto, California., Cohen HJ; Department of Pediatrics, Stanford University School of Medicine, Stanford, California., Kirkpatrick JN; Division of Cardiology, Department of Bioethics and Humanities, University of Washington Medical Center, Seattle, Washington., Blume ED; Department of Cardiology, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts.
Jazyk: angličtina
Zdroj: Pediatric transplantation [Pediatr Transplant] 2019 May; Vol. 23 (3), pp. e13359. Date of Electronic Publication: 2019 Feb 07.
DOI: 10.1111/petr.13359
Abstrakt: Objectives: This study's objective was to investigate compassionate ventricular assist device deactivation (VADdeact) in children from the perspective of the pediatric heart failure provider.
Background: Pediatric VAD use is a standard therapy for advanced heart failure. Serious adverse events may affect relative benefit of continued support, leading to consideration of VADdeact. Perspectives and practices regarding VADdeact have been studied in adults but not in children.
Methods: A web-based anonymous survey of clinicians for pediatric VAD patients (<18 years) was sent to list-serves for the ISHLT Pediatric Council, the International Consortium of Circulatory Assist Clinicians Pediatric Taskforce, and the Pediatric Cardiac Intensivist Society.
Results: A total of 106 respondents met inclusion criteria of caring for pediatric VAD patients. Annual VAD volume per clinician ranged from <4 (33%) to >9 (20%). Seventy percent of respondents had performed VADdeact of a child. Response varied to VADdeact requests by parent or patient and was influenced by professional degree and region of practice. Except for the scenario of intractable suffering, no consensus on VADdeact appropriateness was reported. Age of child thought capable of making informed requests for VADdeact varied by subspecialty. The majority of respondents (62%) do not feel fully informed of relevant legal issues; 84% reported that professional society supported guidelines for VADdeact in children had utility.
Conclusion: There is limited consensus regarding indications for VADdeact in children reported by pediatric VAD provider survey respondents. Knowledge gaps related to legal issues are evident; therefore, professional guidelines and educational resources related to pediatric VADdeact are needed.
(© 2019 Wiley Periodicals, Inc.)
Databáze: MEDLINE
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