Specialist Palliative Care Consultations in COVID-19 Patients in the ICU—A Retrospective Analysis of Patient Characteristics and Symptoms at a German University Hospital

Abstract

COVID-19 patients who may require invasive therapeutic procedures such as extracorporeal membrane oxygenation (ECMO) have high symptom burden and in-hospital mortality. In addition, awake patients on ECMO are new in the intensive care unit (ICU) setting. Inpatient specialist palliative care (sPC) provides support such as symptom control on a physical, psychosocial and spiritual level. The field of sPC in COVID-19 patients is still new and important to investigate. We aim to analyze sPC of COVID-19 patients in the ICU with regard to patient characteristics and symptoms from a palliative care perspective. We conducted a retrospective analysis (03/2020–04/2021) and identified 51 ICU patients receiving sPC. The statistical analysis included descriptive statistics and comparisons of symptoms. The first sPC contact of patients (mean age 69.5 years, 62.7% male) was around 14 days after COVID-19 confirmation, and 43% were treated with ECMO therapy. The baseline symptom burden was high with a focus on weakness (100%), tiredness (98%), dyspnea (96%) and family burden (92%). The symptom intensity significantly decreased during the time period of sPC and COVID-19 treatment (t(99) = 3.119, p = 0.003, d = 0.437). These results help intensivists and sPC clinicians to identify symptoms and the need for sPC in COVID-19 patients. However, studies with prospective and controlled designs need to follow.

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

“…At our institution, sPC integration is initiated upon request representing the “consultative model” (26). Only during the COVID-19 pandemic, automated sPC integration occur in all COVID-19 extracorporeal membrane oxygenation patients (27). 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.…”

More than the sum of its parts—A constructivist grounded-theory study on specialist palliative care during crises like the COVID pandemic

“…While the principles of palliative care do not change during a crisis, specific adaptations seem unavoidable as an additional layer of complexity is added to the complex system of specialist palliative care. 5 Staff shortages, impeded communication, visiting and contact restrictions 6 up to the complete closure of palliative care units 7 since the early course of the COVID pandemic are examples of substantial problems in providing adequate palliative care in crisis times. Furthermore, previous studies identified organizational responses by specialist palliative care teams, for example, increasing outreach or initiating telehealth approaches where possible.…”