Introduction: Temporary mechanical circulatory support (MCS) device utilization has risen exponentially, with over 2,000 devices implanted annually in the United States as a bridge to transplantation, recovery, or decision. The increasing utilization has created challenges related to device withdrawal at end-of-life. Despite technological advances, a proportion of patients experience irreversible deterioration, necessitating compassionate device deactivation. Healthcare providers report this process as complex, emotionally challenging, and poorly standardized. This quality improvement project investigated whether implementing a standardized protocol for compassionate deactivation MCS would enhance ICU staff comfort and knowledge of the withdrawal process.
Methods: Following literature review, a multidisciplinary team developed a comprehensive protocol and actionable checklist for compassionate deactivation of MCS devices. A pre-implementation and post-implementation survey design was employed over three months to assess staff knowledge and comfort with the withdrawal process. Statistical analysis included two-sample t-tests for normally distributed comfort scores and Wilcoxon rank-sum tests for knowledge scores.
Results: Staff comfort with compassionate withdrawal significantly improved following protocol implementation. Mean total comfort scores increased from 36.32 to 39.01 (p=0.011). When controlling for previous experience with compassionate withdrawal, post-intervention participants scored 2.85 points higher than the pre-intervention group (p=0.007). Knowledge scores showed a slight, decrease from 2.24 to 1.79 (p=0.125). Written guidelines remained the most valued resource across both periods (81.1% pre-intervention, 68.4% post-intervention), with staff increasingly valuing personal experience post-implementation (45.9% to 52.6%).
Conclusions: Implementation of a standardized protocol for compassionate withdrawal of MCS devices significantly improved staff comfort with this process. The protocol established a meaningful foundation for standardizing this complex clinical process, enhancing end-of-life care for patients with MCS devices and their families. Institutional support and integration into formal training programs may further sustain improvements in this critical aspect of end-of-life care.
