Extracorporeal membrane oxygenation after stem cell transplant

Clinical decision-making in the absence of evidence

Rachel K. Wolfson, Madelyn D. Kahana, James B. Nachman, John Lantos

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objective: To discuss the ethical dilemmas that arise in considering innovative therapies for critically ill children when there is little data to support their use. Design: Case report of a 13-yr-old patient after autologous peripheral blood stem cell transplant for stage III neuroblastoma with sepsis and hemodynamic instability who survived to discharge after a 6-day course of extracorporeal membrane oxygenation (ECMO) support. The case serves as a source of discussion of the following: the use of available data in deciding to proceed with an unproved therapy, the approach to conversations to obtain informed consent, and the need for institutional oversight and hypothesis-driven data collection to advance pediatric critical care. Setting: Pediatric intensive care unit at a university hospital. Patient: One adolescent with stage III neuroblastoma. Results: Despite a lack of data to support the use of ECMO in a neutropenic oncology patient after autologous peripheral blood stem cell transplant, our patient had clinical features that suggested he was a reasonable ECMO candidate. His family gave informed consent to use ECMO and he survived. It is ethical to consider and use innovative therapies when patient characteristics are suggestive that the therapy may be successful even in the absence of evidence. This requires physicians' attention to the best interest of the patient and should occur in the setting of informed consent and rigorous data collection. Conclusions: The boundaries among standard therapy, innovative therapy, and research can be quite fluid. This case illustrates the ethical imperative to consider therapies that may be appropriate for a critically ill child even without evidence predictive of success, to have entry criteria and treatment protocols for such therapies, and to collect data from such experiences to advance the standard of care.

Original languageEnglish (US)
Pages (from-to)200-203
Number of pages4
JournalPediatric Critical Care Medicine
Volume6
Issue number2
DOIs
StatePublished - Mar 2005
Externally publishedYes

Fingerprint

Extracorporeal Membrane Oxygenation
Stem Cells
Transplants
Investigational Therapies
Informed Consent
Neuroblastoma
Critical Illness
Therapeutics
Pediatric Intensive Care Units
Critical Care
Standard of Care
Clinical Protocols
Clinical Decision-Making
Sepsis
Hemodynamics
Pediatrics
Physicians
Research

Keywords

  • Ethics
  • Evidence-based medicine
  • Informed consent
  • Pediatric extracorporeal membrane oxygenation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Extracorporeal membrane oxygenation after stem cell transplant : Clinical decision-making in the absence of evidence. / Wolfson, Rachel K.; Kahana, Madelyn D.; Nachman, James B.; Lantos, John.

In: Pediatric Critical Care Medicine, Vol. 6, No. 2, 03.2005, p. 200-203.

Research output: Contribution to journalArticle

Wolfson, Rachel K. ; Kahana, Madelyn D. ; Nachman, James B. ; Lantos, John. / Extracorporeal membrane oxygenation after stem cell transplant : Clinical decision-making in the absence of evidence. In: Pediatric Critical Care Medicine. 2005 ; Vol. 6, No. 2. pp. 200-203.
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