Aim To reduce distress with the end of life process for staff and families within pediatric ECMO

Background Pediatric extracorporeal membrane oxygenation (pECMO) is a high risk of mortality therapy. Historically across units in our hospital utilizing ECMO services, there has been a lack of clarity and consistency regarding the end of life (EOL) process and family decision-making for patients cannulated to ECMO. Since a large percentage of ECMO patients progressing to withdrawal of support result in EOL, we seek to promote a patient/family-focused EOL process to reduce distress and improve family satisfaction after EOL.

Outcomes An evidence-based quality improvement (EBQI) analysis was performed on EOL and compassionate deactivation (CD) within pECMO. We recognized four items to promote or standardize within the EOL process: Promotion of family participation in their child’s EOL care, a standardized process for ECMO circuit discontinuation, in-depth education on EOL practices for all healthcare providers involved in the care of pECMO patients, and collaboration between the healthcare team and family on a unified plan for withdrawal of support.

Implementation Plan We will obtain surveys from our staff on the technical and psychological aspects of the EOL process, and survey the families of our pECMO patients post CD. The research goal is to recognize whether a standardized process for EOL on ECMO provides the healthcare team with the tools to effectively provide compassionate EOL care that is family-centered and least distressful for families and staff.

Keywords: Extracorporeal membrane oxygenation, compassionate deactivation, end of life, critical care, palliative care, death