ISHLT2022 Roving Reporters – Reports from Mechanical Circulatory Support

Saturday, 30 April, 2022

This session explored therapeutic considerations including palliation in patients with advanced heart failure where options are limited.

A Life After ECMO Is (Not) Possible: When Nobody Wants Your Patient
Silvia Mariani, MD
, Hannover Medical School, Hannover, Germany

A Life After ECMO Only As Destination Therapy
Alessandro Barbone, MD
, PhD, Humanitas Research Hospital, Rozzano, Italy

A Life After ECMO Is (Always) Possible: The Perspective of an LVAD and Transplant Center
Udo Boeken, MD
, University of Düsseldorf, Düsseldorf, Germany

When the Doctor Says NO: Ethical Implications of a Difficult Choice
Shunichi Nakagawa, MD
, Columbia University Medical Center, New York, NY USA

Systems of care are regionalized throughout the world, such that not every center has capacity for advanced therapies. Have you ever wondered what happens to your patient on veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) when there are no options, limited options, or full options for advanced therapies at your center? The first three talks of this symposia, presented by Drs. Mariani, Barbone, and Boeken, reviewed important considerations for patient care under these different circumstances and center-specific perspectives, including how to wean a patient from VA-ECMO or when to engage palliative care when there is futility, and when and how to safely transfer patients to centers with advanced therapies when your center has limited capacity for mechanical heart pumps or heart transplant

The final talk, presented by Dr. Nakagawa, reviewed a three-stage protocol for how to approach difficult decisions when a patient is ineligible for advanced therapies:
  1. Share knowledge around the prognosis of the patient in futile ECMO as a bridge to “nowhere,” the confinement to the ICU, and the limited survival from days to weeks.
  2. Clarify goals of care by trying to understand what is important to the patient, to understand their hopes and worries, and to understand what is meaningful.
  3. Negotiate treatment options within this discussion—using shared decision making and discussing the involvement of palliative care.
– Summary by Varinder Randhawa, MD, PhD