title: Ethical dilemma: offering short-term extracorporeal membrane oxygenation support for terminally ill children who are not candidates for long-term mechanical circulatory support or heart transplantation.
abstract: The use of extracorporeal membrane oxygenation (ECMO) in terminally ill pediatric patients who are not candidates for long-term mechanical circulatory support or heart transplantation requires careful deliberation. We present the case of a 16-year-old female with a relapse of acute lymphoid leukemia and acute-on-chronic cardiomyopathy who received short-term ECMO therapy. In addition, we highlight several ethical considerations that were crucial to this patient's family-centered care and demonstrate that this therapy can be accomplished in a manner that respects patient autonomy and family wishes.
authors.affiliation: Department of Critical Care Medicine, Children's National Medical Center, Washington, DC, USA.
authors.forename: Venkat
authors.initials: V
authors.lastname: Shankar
authors.forename: John P
authors.initials: JP
authors.lastname: Costello
authors.forename: Syed M
authors.initials: SM
authors.lastname: Peer
authors.forename: Darren
authors.initials: D
authors.lastname: Klugman
authors.forename: Dilip S
authors.initials: DS
authors.lastname: Nath
mesh_terms: D000293:Adolescent; D018943:Anthracyclines / Q000009:adverse effects; D001243:Assisted Circulation; D009202:Cardiomyopathies / Q000139:chemically induced / Q000628:therapy*; D018450:Disease Progression; D015199:Extracorporeal Membrane Oxygenation / Q000941:ethics*; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D016027:Heart Transplantation; D006801:Humans; D018447:Medical Futility / Q000941:ethics*; D010360:Patient Transfer; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy; D012008:Recurrence; D013727:Terminal Care / Q000941:ethics*
chemical_list: D018943:Anthracyclines
keywords: ECMO; circulatory assistance; ethics; heart transplantation; intensive care