Related Experiment Video
Updated: Jul 8, 2026
A Cost-effective and Reliable Method to Predict Mechanical Stress in Single-use and Standard Pumps
Published on: August 5, 2015
"Do we have to replace the balloon pump when it fails?"
Insights
This case highlights the ethical dilemma of determining decision-making capacity in patients with advanced heart failure. It questions the obligation to continue mechanical circulatory support when a patient may lack capacity.
Area of Science:
- Cardiology
- Medical Ethics
- Critical Care Medicine
Background:
- Patient presented with coronary artery disease and ischemic cardiomyopathy, requiring advanced heart failure support.
- Initial acceptance for left ventricular assist device (LVAD) was pending cognitive assessment.
Observation:
- Patient developed cardiogenic shock, necessitating intra-aortic balloon pump (IABP) placement.
- IABP dependency and deconditioning occurred within two weeks.
- Attending physician and medical review board determined lack of decision-making capacity, declining LVAD candidacy.
Findings:
- Heart failure and CICU teams recommended terminal weaning of IABP and comfort care.
- Family disagreed, citing patient's continued engagement and eating.
- Ethical impasse reached regarding continued mechanical support.
Implications:
- This case underscores the complexities in assessing patient capacity for medical decisions in critical care settings.
- It raises questions about the ethical obligations of healthcare providers when faced with conflicting views between medical teams and families.
- The scenario prompts a discussion on the balance between aggressive treatment and patient-centered comfort care in advanced heart failure.
Abstract:
Mrs. Duong had coronary artery disease, ischemic cardiomyopathy, and mildly altered mental status when her case was presented before an advanced heart therapy medical review board. She was accepted for left ventricular assist device placement pending additional insight into her cognitive state. Before the LVAD could be implanted, however, Mrs. Duong went into cardiogenic shock, and her heart failure team placed an intra-aortic balloon pump in her subclavian artery. Within two weeks, Mrs. Duong became IABP dependent and deconditioned. The attending deemed her as lacking capacity to make complex medical decisions, and the medical review board officially declined her for LVAD placement. The heart failure and CICU teams feel that Mrs. Duong is not being helped by the care they are giving her. They recommend terminal weaning of the IABP and initiation of comfort care. Her family disagrees, pointing to activities like continued eating and interacting with family. At an impasse after yet another family meeting, the attending for the heart failure team asks the clinical ethics consultant, "Do we have to replace the balloon pump when it fails?"
