Clinician Perspectives on Compassionate Deactivation of Pediatric Ventricular Assist Devices

Following ventricular assist device (VAD) placement, families and clinicians often have differing perspectives. When adverse events reduce patients' quality of life, families and clinicians question the desirability of continuing VAD support. Given the increasing use of VAD in pediatrics, pediatric-specific guidelines for the process of compassionate deactivation (CD) of VAD are needed, based in part on the perspectives of pediatric heart failure clinicians. In this qualitative study, we used a semi-structured interview guide focused on CD. Twenty-one clinicians participated. The central theme characterizing the process of CD-VAD is Making the Decision to CD-VAD . Five categories emerged: 1) communication strategies, 2) relationships and trust, 3) importance of time, 4) emotional toll, and 5) redirecting care. Consensus in decision-making was achieved through collective discussions among staff and care team meetings, including families. Clinicians reported experiencing moral and emotional distress, primarily due to witnessing patient suffering, triggered by close relationships with patients and families, and discord around CD decisions. This study clarifies challenges posed by CD-VAD. Understanding these challenges is a necessary first step in the development of guidance to provide cardiac care integrated with pediatric palliative care (PPC) for children with implanted VAD, and to respond appropriately to circumstances where CD may be warranted.