Termination of extracorporeal membrane oxygenation for cardiac support.

Abstract:

:The determination of when to stop extracorporeal membrane oxygenation (ECMO) rests upon demonstration of the return of adequate cardiac function to support vital organs and permit subsequent recovery. In general, patients with myocardial stun will recover function within several days. Factors that limit recovery include elevated end diastolic pressures leading to marginal myocardial perfusion, ongoing organ damage, massive anasarca, or progressive deterioration in lung function. Following a trial of slow weaning of ECMO support to condition the heart to take over the entire system flow requirements, decannulation can be accomplished in a standard fashion. When weaning is not successful and additional time does not lead to adequate recovery of cardiac function, physicians and nurses must be prepare to realistically advise families regarding such options as cardiac transplantation or withdrawal of support. It is critically important to provide an open and nonjudgmental environment for families to make these difficult decisions. The greatest difficulties involve ethical and emotional decisions that need to be made in a timely fashion to prevent undo burden on the patient when further ECMO support is futile.

journal_name

Artif Organs

journal_title

Artificial organs

authors

Steinhorn DM

doi

10.1046/j.1525-1594.1999.06445.x

subject

Has Abstract

pub_date

1999-11-01 00:00:00

pages

1026-30

issue

11

eissn

0160-564X

issn

1525-1594

pii

aor6445

journal_volume

23

pub_type

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