Top ten tips palliative care clinicians should know about working with adults receiving extracorporeal membrane oxygenation Review


Authors: Grouls, A.; Dobbie, K.; Neuendorf, K.; Nakagawa, S.; Young, A.; Rosa, W. E.; Akkanti, B.
Review Title: Top ten tips palliative care clinicians should know about working with adults receiving extracorporeal membrane oxygenation
Abstract: Extracorporeal membrane oxygenation (ECMO) is an invasive intervention that is both resource- and labor-intensive. It can also be emotionally challenging for all involved. Palliative care (PC) clinicians can support adult patients, families, surrogate decision makers, and the interdisciplinary team (IDT) throughout ECMO, starting at the time of ECMO initiation through discontinuation and to bereavement in the event of a patient's death. In addition to knowing the basics of ECMO circuitry, indications to start ECMO, and the complex decision points throughout treatment, PC clinicians must understand the critical need for specialist and IDT coordination when discussing prognosis and resuscitation, clarifying goals of care, and identifying future treatment options. Not only are PC clinicians' skills needed to manage symptoms and psychosocial needs but also during end-of-life care, which can often be rapid and requires team consensus to ensure a smooth clinical process with continuous family support. While using their expert communication skills to conduct frequent family meetings, ideally starting within one week of ECMO initiation and weekly thereafter, PC clinicians offer a consistent presence and "big picture"perspective for patients and families, while other members of the IDT may rotate regularly. PC clinicians will also be called on to assist members of the IDT to debrief about the understandable moral and emotional distress they may experience while providing care for patients receiving ECMO and their families. © Copyright 2023, Mary Ann Liebert, Inc., publishers 2023.
Keywords: adult; palliative care; palliative therapy; terminal care; resuscitation; extracorporeal oxygenation; critical illness; symptom control; extracorporeal membrane oxygenation; humans; prognosis; human; mechanical circulatory support; cardiac conditions; pulmonary conditions
Journal Title: Journal of Palliative Medicine
Volume: 26
Issue: 9
ISSN: 1096-6218
Publisher: Mary Ann Liebert, Inc  
Date Published: 2023-09-01
Start Page: 1270
End Page: 1276
Language: English
DOI: 10.1089/jpm.2023.0017
PUBMED: 36791329
PROVIDER: scopus
DOI/URL:
Notes: Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed -- Source: Scopus
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  1. William   Rosa
    202 Rosa