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Pediatr Transplant. 2019 Feb 7:e13359. doi: 10.1111/petr.13359. [Epub ahead of print]

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

Author information

1
Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
2
Anesthesiology, Perioperative and Pain Medicine, Stanford Center for Biomedical Ethics, Stanford University, Palo Alto, California.
3
Division of Cardiology, Department of Bioethics and Humanities, University of Washington Medical Center, Seattle, Washington.
4
Department of Cardiology, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts.

Abstract

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.

KEYWORDS:

decision-making; palliative care; pediatric mechanical circulatory support; ventricular assist device

PMID:
30734422
DOI:
10.1111/petr.13359

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