Ethical dilemma: offering short-term extracorporeal membrane oxygenation support for terminally ill children who are not candidates for long-term mechanical circulatory support or heart transplantation

World J Pediatr Congenit Heart Surg. 2014 Apr;5(2):311-4. doi: 10.1177/2150135113509820.

Abstract

The use of extracorporeal membrane oxygenation (ECMO) in terminally ill pediatric patients who are not candidates for long-term mechanical circulatory support or heart transplantation requires careful deliberation. We present the case of a 16-year-old female with a relapse of acute lymphoid leukemia and acute-on-chronic cardiomyopathy who received short-term ECMO therapy. In addition, we highlight several ethical considerations that were crucial to this patient's family-centered care and demonstrate that this therapy can be accomplished in a manner that respects patient autonomy and family wishes.

Keywords: ECMO; circulatory assistance; ethics; heart transplantation; intensive care.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Anthracyclines / adverse effects
  • Assisted Circulation
  • Cardiomyopathies / chemically induced
  • Cardiomyopathies / therapy*
  • Disease Progression
  • Extracorporeal Membrane Oxygenation / ethics*
  • Female
  • Heart Failure / therapy*
  • Heart Transplantation
  • Humans
  • Medical Futility / ethics*
  • Patient Transfer
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy
  • Recurrence
  • Terminal Care / ethics*

Substances

  • Anthracyclines