24, 74, 75, 70
Decision points do not arise on a circuit; they must be manufactured and written into the notes in advance with a date, a question, the information required, the people present and what happens if the answer is no. This also explains why communication interventions aimed at surrogate participation have had little measurable effect on ECMO trajectories - they target a decision point the structure of care does not produce.
Not applicable - qualitative
DOI 10.1097/sla.0000000000004838
Focused ethnography of how escalation and withdrawal decisions are actually made
Two units, one country, qualitative design; not ECPR-specific. Structured abstract only. [VERIFICATION REQUIRED]
Following ECMO initiation, treatment was escalated as complications mounted until the patient either could be decannulated or interventional options were exhausted. Families were well-informed about treatment and prognosis but played minimal roles in shaping the trajectory of care. Discussion between clinicians and families about prognosis and goals was frequent but did not occasion decision-making moments.
Two academic cardiothoracic intensive care units; 380 hours of direct observation, 34 weekly interviews with families of 20 ECMO patients, 13 clinician interviews