• J Clin Med · Jan 2021

    Review

    Do-(Not-)Mechanical-Circulatory-Support Orders: Should We Ask All Cardiac Surgery Patients for Informed Consent for Post-Cardiotomy Extracorporeal Life Circulatory Support?

    • Jorik Simons, Martje Suverein, Walther van Mook, Kadir Caliskan, Osama Soliman, van de PollMarcelM0000-0002-3302-4063Department of Intensive Care Medicine, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands.Department of Surgery, NUTRIM School for Nutrition and Translational Research in Metabolism, Maas, Thijs Delnoij, Jos Maessen, Barend Mees, and Roberto Lorusso.
    • Department of Cardio-Thoracic Surgery, CARIM School for Cardiovascular Diseases, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands.
    • J Clin Med. 2021 Jan 20; 10 (3).

    AbstractPost-cardiotomy extracorporeal life support (PC-ECLS) has seen a substantial increase in use over the past 10 years. PC-ECLS can be a life-saving procedure and is mostly applied in the presence of unexpected, severe cardio-respiratory complication. Despite PC-ECLS being critical in allowing for organ recovery, it is unfortunately closely connected with an unpredictable outcomes, high morbidity, and, even in the case of cardiac function improvement, potential sustained disabilities that have a life-changing impact for the patient and his or her family. Since the decision to start PC-ECLS is made in an acute setting, there is often only limited or no time for self-determined choices. Due to the major impact of the intervention, it would be highly desirable to obtain informed consent before starting PC-ECLS, since the autonomy of the patient and shared-decision making are two of the most important ethical values in modern medicine. Recent developments regarding awareness of the impacts of a prolonged intensive care stay make this a particularly relevant topic. Therefore, it would be desirable to develop a structural strategy that takes into account the likelihood of such an intervention and the wishes and preferences of the patient, and thus the related autonomy of the patient. This article proposes key points for such a strategy in the form of a PC-ECLS informed consent, a do-(not-)mechanical-circulatory-support order (D(N)MCS), and specific guidelines to determine the extent of the shared decision making. The concept presented in this article could be a starting point for improved and ethical PC-ECLS treatment and application.

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