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

• Published in: Pediatric transplantation Vol. 23; no. 3; pp. e13359 - n/a
• Main Authors: Kaufman, Beth D., Hollander, Seth A., Zhang, Yulin, Chen, Sharon, Bernstein, Daniel, Rosenthal, David N., Almond, Christopher S., Murray, Jenna M., Burgart, Alyssa M., Cohen, Harvey J., Kirkpatrick, James N., Blume, Elizabeth D.
• Format: Journal Article
• Language: English
• Published: Denmark Wiley Subscription Services, Inc 01.05.2019
• Subjects: Adolescent; Attitude of Health Personnel; Canada; Child; Child, Preschool; Children; Congestive heart failure; Cross-Sectional Studies; Deactivation; Decision Making; Heart failure; Heart Failure - therapy; Heart Transplantation; Heart-Assist Devices; Humans; Informed Consent By Minors; International Cooperation; Internet; Nurses; palliative care; Palliative Care - methods; pediatric mechanical circulatory support; Pediatrics; Pediatrics - methods; Physicians; Polls & surveys; Practice Patterns, Physicians; Surveys and Questionnaires; Treatment Outcome; United States; Ventricle; ventricular assist device; Withholding Treatment - ethics; Withholding Treatment - statistics & numerical data; Canada; United States; ventricular assist device; pediatric mechanical circulatory support; decision-making; palliative care
• ISSN: 1397-3142; 1399-3046
• DOI: 10.1111/petr.13359

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.