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Abstract Details

Predictors of Withdrawal of Life Sustaining Treatments in ECMO Patients
Neuro Trauma, Critical Care, and Sports Neurology
P16 - Poster Session 16 (5:30 PM-6:30 PM)
13-017
To review and characterize patients on extracorporeal membrane oxygenation (ECMO) whom experienced withdrawal of life sustaining treatment (WLST).
As ECMO use increases and survival rates improve, data regarding withdrawal of care among this population remains scant.  Poor outcomes following ECMO are largely related to neurological injury and information on neurological prognostication during ECMO support is limited. Understanding the characteristics of WLST after ECMO initiation and how this relates to neurological prognosis will better inform end of life care.
All patients who underwent ECMO support at Johns Hopkins Hospital were identified in a prospective observational cohort from 2018-2019. Clinical and demographic information were abstracted via chart review and predictors of WLST were assessed using descriptive statistics as appropriate.

Of 77 patients with ECMO support, 52 patients (67.5%) died. WLST was the cause of death in 44/52 patients (57.1%). WLST occurred at a median of 6 days (range: 1-59 days). Of the WLST patients, VA was the most common form of ECMO (41 patients) followed by VV ECMO (3 patients).  The primary reasons for WLST was family request (88.6%), multi-organ failure (31.8%), primary diagnosis incompatible with life (27.2%), non-CNS hemorrhage (13.6%), brain death (11.4%), ischemic stroke (ischemic stroke (6.8%), brain hemorrhage (4.5%), and other (2%).  Combining neurological causes identified as reason for WLST in 22.7% of patients. 56.8% of the patients had more than one reason listed for WLST. Day of demise was typically the same day after initiation of WLST. 

Most patients who died in the prospective ECMO cohort experienced WLST. The most common reason for WLST was family request. Patients usually died the same day as WLST. Further analysis will be conducted on a retrospective cohort and on larger national database information to compare demographic data as well as further investigate neurological factors relating to WLST.
Authors/Disclosures
Julia Carlson, MD (University of North Carolina Chapel Hill Hospital)
PRESENTER 		Dr. Carlson has received publishing royalties from a publication relating to health care.
No disclosure on file
No disclosure on file
No disclosure on file
Romergryko G. Geocadin, MD, FÂ鶹´«Ã½Ó³»­ (Johns Hopkins University School of Medicine) Dr. Geocadin has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Medicolegal Consulting.
Julia Carlson, MD (University of North Carolina Chapel Hill Hospital) Dr. Carlson has received publishing royalties from a publication relating to health care.