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Ethical considerations for post-cardiotomy extracorporeal membrane oxygenation*

Published online by Cambridge University Press:  18 January 2013

Constantine Mavroudis ,
Constantine D. Mavroudis ,
Jeanette Green ,
Robert M. Sade ,
Jeffrey P. Jacobs  and
Eric Kodish
Constantine Mavroudis*
Affiliation:
Johns Hopkins Children's Heart Surgery, Florida Hospital for Children, Orlando, Florida, United States of America
Constantine D. Mavroudis
Affiliation:
Division of Cardiothoracic Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
Jeanette Green
Affiliation:
Center for Pediatric Research and Outcomes, Florida Hospital for Children, Orlando, Florida, United States of America
Robert M. Sade
Affiliation:
Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina, United States of America
Jeffrey P. Jacobs
Affiliation:
Johns Hopkins Children's Heart Surgery, All Children's Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, and Orlando, Florida, United States of America
Eric Kodish
Affiliation:
Center for Ethics, Humanities and Spiritual Care, Cleveland Clinic, Cleveland, Ohio, United States of America
*
Correspondence to: Dr C. Mavroudis, MD, Director, Congenital Heart Institute, Florida Hospital for Children; Site Director, Johns Hopkins Children's Heart Surgery, Florida Hospital for Children; 2501 North Orange Avenue, Suite 540, Orlando, Florida 32804, United States of America. Tel: +1 407 303 3692; Fax: +1 407 303 3634; E-mail: Constantine.Mavroudis.MD@flhosp.org
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Abstract

Significant advances have been made in extracorporeal life support, which has resulted in the increased use of post-cardiotomy extracorporeal membrane oxygenation. Retrospective studies have contributed to the ongoing evolution of selection criteria for post-cardiotomy extracorporeal membrane oxygenation. Current indications include failure to wean from cardiopulmonary bypass, haemodynamic collapse, pulmonary hypertension, post-repair of hypoplastic left heart syndrome, or need for bridge to transplantation. Short- and mid-term results are improving. Ethical concerns still attend the process, however. Moral risks related to post-cardiotomy extracorporeal membrane oxygenation may be encountered before, during, and after the open heart procedure. At each stage of the decision-making process, moral risks are encountered by many factors that may result in decisions that may be contrary to the best interests of the patient, parents, or use of shared societal resources. These moral risks centre around the selection process, informed consent, decision making in the operating room, and post-operative maintenance of extracorporeal membrane oxygenation. Consideration of such risks is affected by questions of haemodynamic stability, haematologic compromise, neurologic status, and family concerns. We conclude that thorough understanding of the relevant scientific literature, heightened awareness of moral risks, and incorporation of ethical tenets in clinical deliberation will guide the clinician to do the right thing.

Keywords

Life supportmoral riskfailure to weancardiopulmonary bypasshaemodynamic collapsepulmonary hypertensionpaediatric extracorporeal membrane oxygenationhypoplastic left heart syndrome
Type
Original Article
Information
Cardiology in the Young , Volume 22 , Issue 6: A Lifelong Interdisciplinary Approach to Common Arterial Trunk, Transposition of the Great Arteries, and Other Evolving Challenges in Paediatric and Congenital Cardiac Disease , December 2012 , pp. 780 - 786
Copyright
Copyright © Cambridge University Press 2012

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Footnotes

*

Presented at the 12th Annual International Symposium on Congenital Heart Disease. February 17–21, 2012 in Saint Petersburg, Florida, United States of America.

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