Palliative Care for Extracorporeal Life Support: Insights From the National Inpatient Sample

Abstract

Background Providing temporary cardiopulmonary support, extracorporeal membrane oxygenation (ECMO) carries a high risk of mortality. Palliative care (PC) may facilitate a patient-centered approach to end-of-life care in order to aid symptom management and provide psychosocial support to families. The present study aimed to identify factors associated with PC consultation and its impact on resource utilization in ECMO. Study Design All adults placed on ECMO at a PC capable center were identified in the 2006-2017 National Inpatient Sample. Indications for ECMO were identified using diagnosis codes and classified into postcardiotomy syndrome, respiratory failure, cardiogenic shock, mixed cardiopulmonary failure, and transplant related. Results Of 41 122 patients undergoing ECMO, 20 514 (49.9%) died in the same hospitalization. Of those, 3951 (19.3%) received a PC consult. Use of PC consults increased significantly from 5.5% in 2006 to 22.8% in 2017 (nptrend<.001). After multivariable risk adjustment, PC consults did not affect costs (β: –$7341, 95% CI: −22 572 to +7888) or duration of hospitalizations (β: −.37 days, 95% CI: −2.76 to +2.02). Conclusion Utilization of PC does not appear to negatively influence resource utilization among non-survivors of ECMO. Increased adaptation of PC in ECMO may improve end-of-life care, a factor that deserves future study.

Palliative Care Impact on COVID-19 Patients Requiring Extracorporeal Membrane Oxygenation

“… 6 PCC is already utilized in about 19% of ECMO cases in the US for patients on ECMO for respiratory failure, cardiogenic shock, thoracic transplantation, amongst other indications. 7 Various studies highlight the prolonged hospitalization course of both survivors and decedents requiring ECMO for COVID, often over a month. 8 , 9 PCC is known to play a role in the care of patients with chronic critical illness, and early integration may be helpful in family-centered ICU care when patients are on ECMO.…”

Perceptions on Specialist Palliative Care Involvement During and After Cardiopulmonary Resuscitation: A Qualitative Study

“…This observation is supported by the results of a study by Emple et al ( 18 ). In this prospective study, moral distress was higher in nurses compared with physicians when caring for patients with mechanical circulatory support and coping strategies differed among the professions ( 19 , 20 ). Although nurses chose “increasing use of palliative care” as the most useful strategy to reduce moral distress, physicians most commonly selected “regular debriefing sessions” ( 18 ).…”

“…In this study, some saw ECLS as just another intensive care measure, whereas others urgently demanded standardized sPC involvement of all ECLS patients due to the high mortality of this procedure. Even though the use of sPC in patients with extracorporeal systems increased in the past years, studies on sPC in CPR-ECLS are scarce ( 19 ).…”

Palliative Care Utilization in Patients Requiring Extracorporeal Membrane Oxygenation: An Observational Study

“…One such study found that PC consultation is not associated with higher cost or longer hospital length of stay in people who died during a hospitalization during which they received ECMO support. 32 Two additional studies analyzed PC utilization in patients on ECMO for whom WLST was requested. 15,19 Although these studies are useful in the context of patients who die while on ECMO, they focus on a subset of patients requiring ECMO support and fail to illustrate PC's utility in patients who are expected to survive.…”