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

Author

Listed:
  • 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)

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.

Suggested Citation

  • Daniel Drewniak & Giovanna Brandi & Philipp Karl Buehler & Peter Steiger & Niels Hagenbuch & Sabine Stamm-Balderjahn & Liane Schenk & Ana Rosca & Tanja Krones, 2022. "Key Factors in Decision Making for ECLS: A Binational Factorial Survey," Medical Decision Making, , vol. 42(3), pages 313-325, April.
    • Handle: RePEc:sae:medema:v:42:y:2022:i:3:p:313-325
    DOI: 10.1177/0272989X211040815
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    References listed on IDEAS

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    1. McDermott, Rose, 2002. "Experimental Methodology in Political Science," Political Analysis, Cambridge University Press, vol. 10(4), pages 325-342.
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