Palliative Extracorporeal Membrane Oxygenation Decannulation: An Ethical, Evidence-Based Approach

Area of Science:

• Critical Care Medicine
• Palliative Care
• Quality Improvement

Background:

• Extracorporeal membrane oxygenation (ECMO) is a life-saving but invasive procedure.
• Complications necessitate reevaluation of care goals, especially when ECMMO becomes non-beneficial.
• Planning for de-escalation and natural death is crucial.

Purpose of the Study:

• Mitigate practice variability in ECMMO initiation, communication, futility determination, and symptom management.
• Improve patient and family experience during de-escalation and transition to comfort-directed care.
• Ensure a comfortable and dignified natural death.

Main Methods:

• Integrated palliative care and conducted a literature review of best practices.
• Established an interprofessional task force for ECMMO de-escalation.
• Developed and implemented new clinical guidelines for consistent, evidence-based care.

Main Results:

• Guideline implementation decreased practice variability, reducing patient and family stress.
• Team members reported decreased secondary trauma and moral distress.
• End-of-life care delivery improved, with enhanced family support and symptom management.

Conclusions:

• Guideline application reduced practice variability in ECMMO de-escalation/decannulation.
• Patient and family preferences were better incorporated into end-of-life care.
• Proactive symptom management and reduced variability led to more comfortable and dignified deaths.