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Hospice and Palliative Medicine
Henry Ford Hospital
Background: Extracorporeal membrane oxygenation (ECMO) is an emerging life-sustaining intervention for patients experiencing critical cardiopulmonary compromise. Despite the promises of this therapy, studies have shown that over 40% of patients receiving ECMO do not survive their hospitalization.1 In light of this, existing research and protocols for weaning ECMO in the setting of medical futility is extremely limited.2,4 Additionally, research suggests that medications may work differently for patients receiving ECMO3, raising questions about the development of future protocols in this patient population.
Case Description: Patient is a 60 year-old female with a history of pulmonary sarcoidosis who was hospitalized for acute-on-chronic hypoxic respiratory failure, complicated by in-hospital cardiac arrest. She was ultimately resuscitated and placed on VA-ECMO as a bridge to lung transplantation. She maintained intact neurologic function after several weeks during her hospitalization, however she developed a retroperitoneal hemorrhage and was subsequently informed that she was no longer a candidate for transplantation. The patient and her family made the decision to discontinue life sustaining therapies, including ECMO. Prior to ECMO wean, she received boluses of IV morphine and ativan, and a morphine infusion was initiated. Her ECMO was weaned to 50% settings, and then discontinued altogether as medications were titrated. Despite this, the patient was noted to have evidence of respiratory distress including accessory muscle use. She died approximately 20 minutes after discontinuation of ECMO.
Conclusion: ECMO is an emerging life-sustaining therapy for some of the most critically ill patients. Despite the high need for palliative care in this patient population, there exists minimal evidence for protocolization of terminal ECMO weans. This presentation will review clinical challenges in delivering palliative care to an awake patient undergoing a terminal ECMO wean, and aims to identify areas of future research, including relief of symptom burden, and minimizing patient/family distress.
Abraham, Jonathan and Rose, Jonathan, "Recommendations for phototherapy during the COVID-19 pandemicEnd of Life Considerations in the ECMO Patient - A Case Presentation" (2020). Case Reports. 124.