311 - Decision-Making Authority for Initiating Extracorporeal Membrane Oxygenation in Pediatric Patients

Extracorporeal membrane oxygenation (ECMO) is a well-established therapy for pediatric patients with severe refractory respiratory or cardiac failure. There is currently limited research guiding the level of involvement of parents and other surrogates in deciding whether to initiate ECMO in pediatric patients.

Objective:

We sought to explore physicians’ opinions surrounding decision-making authority and the role of surrogate decision-makers when considering ECMO initiation.

Design/Methods:

This was a national cross-sectional survey of three groups of attending physicians: pediatric intensive care (PICU) physicians, neonatal intensive care (NICU) physicians, and pediatric surgeons. 30 of the largest pediatric ECMO centers across the U.S. were included and Qualtrics surveys were randomly distributed via email to 5 PICU attendings, 5 NICU attendings, and 5 pediatric surgery attendings at each institution. A panel of expert attending physicians evaluated the survey for face and content validity. The finalized survey contained 34 items. Responses were dichotomized into agree versus disagree categories and then compared statistically using Chi-squared or Fisher exact tests.

Results:

89 of 431 (21%) surveys have been completed for this interim analysis. The demographics of respondents are outlined in Table 1. There is wide variance amongst physicians regarding whether disability and cost should be considerations in the decision to offer ECMO (Figures 1 and 2). PICU physicians were less likely than neonatologists and surgeons to agree with shared decision-making being an appropriate strategy for ECMO initiation (PICU 63%, NICU 96%, surgeons 92%, p=0.001). Surgeons and neonatologists were more likely than PICU physicians to agree that clinicians should always discuss the possibility of ECMO with surrogate decision-makers even if they will not offer it (PICU 13%, NICU 32%, surgeons 38%, p=0.04). Surgeons and neonatologists were also more likely than PICU physicians to agree that surrogates should always be notified if it is decided their child is not an ECMO candidate (PICU 15%, NICU 44%, surgeons 58%).

Conclusion(s):

Pediatric intensivists, neonatologists, and pediatric surgeons have differing beliefs regarding the involvement of surrogate decision-makers in ECMO initiation. Surgeons and neonatologists favor more actively involving surrogates in decision-making surrounding ECMO than pediatric intensive care physicians. Further studies are needed to explore the opinions of parents and surrogates as well as other members of the medical team.