Key Factors in Decision Making for ECLS: A Binational Factorial Survey

Daniel Drewniak, Giovanna Brandi, Philipp Karl Buehler, Peter Steiger, Niels Hagenbuch, Sabine Stamm-Balderjahn, Liane Schenk, Ana Rosca and Tanja Krones
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Daniel Drewniak: Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
Giovanna Brandi: IInstitute of Intensive Medicine, University Hospital of Zurich, Zurich, Switzerland
Philipp Karl Buehler: IInstitute of Intensive Medicine, University Hospital of Zurich, Zurich, Switzerland
Peter Steiger: IInstitute of Intensive Medicine, University Hospital of Zurich, Zurich, Switzerland
Niels Hagenbuch: Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
Sabine Stamm-Balderjahn: IInstitute of Medical Sociology and Rehabilitation Science, Charité–Universitätsmedizin Berlin, Berlin, Germany
Liane Schenk: IInstitute of Medical Sociology and Rehabilitation Science, Charité–Universitätsmedizin Berlin, Berlin, Germany
Ana Rosca: Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
Tanja Krones: IInstitute of Biomedical Ethics and History of Medicine, Clinical Ethics Unit, University Hospital Zürich, University of Zurich, Zurich, Switzerland

Medical Decision Making, 2022, vol. 42, issue 3, 313-325

Abstract: Background Extracorporeal life support (ECLS) provides support to patients with cardiopulmonary failure refractory to conventional therapy. While ECLS is potentially life-saving, it is associated with severe complications; decision making to initiate ECLS must, therefore, carefully consider which patients ECLS potentially benefits despite its consequences. Objective To answer 2 questions: First, which medically relevant patient factors influence decisions to initiate ECLS? Second, what are factors relevant to decisions to withdraw a running ECLS treatment? Methods We conducted a factorial survey among 420 physicians from 111 hospitals in Switzerland and Germany. The study included 2 scenarios: 1 explored willingness to initiate ECLS, and 1 explored willingness to withdraw a running ECLS treatment. Each participant responded to 5 different vignettes for each scenario. Vignettes were analyzed using mixed-effects regression models with random intercepts. Results Factors in the vignettes such as patients’ age, treatment costs, therapeutic goal, comorbidities, and neurological outcome significantly influenced the decision to initiate ECLS. When it came to the decision to withdraw ECLS, patients’ age, days on ECLS, criteria for discontinuation, condition of the patient, comorbidities, and neurological outcome were significant factors. In both scenarios, patients’ age and neurological outcome were the most influential factors. Conclusions This study provided insights into physicians’ decision making processes about ECLS initiation and withdrawal. Patients’ age and neurological status were the strongest factors influencing decisions regarding initiation of ECLS as well as for ECLS withdrawal. The findings may contribute to a more refined understanding of complex decision making for ECLS.

Keywords: extracorporeal life support; decision making; factorial survey; age; neurological status (search for similar items in EconPapers)
Date: 2022
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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:42:y:2022:i:3:p:313-325

DOI: 10.1177/0272989X211040815

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