Current Pediatrics Reports

, Volume 7, Issue 4, pp 168–175 | Cite as

Providing Compassionate End of Life Care in the Setting of Mechanical Circulatory Support

  • Anna JoongEmail author
  • Sabrina F. Derrington
  • Angira Patel
  • Philip T. Thrush
  • Kiona Y. Allen
  • Bradley S. Marino
Pediatric Palliative Care (KS Hoehn, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Pediatric Palliative Care


Purpose of Review

To outline key elements in providing compassionate end-of-life care for pediatric patients with end-stage heart failure on mechanical circulatory support (MCS) such as extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VADs).

Recent Findings

Approximately one in five pediatric patients with end-stage heart failure die on VAD support, with higher mortality associated with patients supported on ECMO. While it is considered ethically and legally permissible to withdraw MCS, pediatric-specific guidelines regarding indications and end-of-life management on MCS are lacking.


A multidisciplinary approach with early consultation of the palliative care team is essential for all patients being considered for MCS. Guiding families through end-of-life care on MCS requires frequent and honest communication by engaging in shared decision-making regarding prognosis and potential clinical pathways, advanced care and preparedness planning, and identifying and meeting patients’/families’ goals of care.


Palliative care Pediatric cardiology Ventricular assist device Extracorporeal mechanical support 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Anna Joong
    • 1
    Email author
  • Sabrina F. Derrington
    • 2
  • Angira Patel
    • 1
  • Philip T. Thrush
    • 1
  • Kiona Y. Allen
    • 1
  • Bradley S. Marino
    • 1
  1. 1.Divisions of Cardiology and Critical Care MedicineNorthwestern UniversityChicagoUSA
  2. 2.Division of Critical Care, Division of Palliative Care, Ann & Robert H. Lurie Children’s Hospital of Chicago, Feinberg School of MedicineNorthwestern UniversityChicagoUSA

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