Extracorporeal membrane oxygenation support: palliative care integration - patient experience and quality of life.

IF 2 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

BMJ Supportive & Palliative Care Pub Date : 2025-05-05 DOI:10.1136/spcare-2025-005503

Bridget H Highet, Kristin Cushenbery, Swapna Sarangi, Anek Jena, Himanshi Banker, Molly Kilpatrick, Maisha Robinson, Pramod K Guru

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引用次数: 0

Abstract

Objective: The pattern and timing of palliative care utilisation and end-of-life characteristics in extracorporeal membrane oxygenation (ECMO)-supported patients remain underused. We wanted to share our centre's experience.

Methods: This is an institutional review board-approved retrospective study of 45 patients who underwent ECMO at a large ECMO centre in North America between January 2013 and July 2018.

Results: Only 28.9% of the ECMO patients received in-hospital palliative care consultation at a median of 18 days (IQR 12-31) after hospitalisation and 10.5 days (IQR 1-28) from ECMO initiation. 1-year mortality was high, with 44% dying during hospitalisation and an additional 13% within the following year. Patients experienced prolonged hospitalisations (median hospital length of stay: 39 days, IQR 19-89) and exhibited high rates of tracheostomy (53%) and renal replacement therapy (60%). Most end-of-life cases involved the withdrawal of life-sustaining therapy during ECMO, yet only 53% had a completed living will.

Conclusion: Our study underscores the need for early initiation of palliative care consultation to enhance symptom management, advance care planning, caregiver support and quality of life for ECMO patients and their families.

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体外膜氧合支持：姑息治疗整合-患者体验和生活质量。

目的：体外膜氧合（ECMO）支持患者姑息治疗的模式和时机以及临终特征仍未得到充分利用。我们想分享我们中心的经验。方法：这是一项机构审查委员会批准的回顾性研究，纳入了2013年1月至2018年7月在北美一家大型ECMO中心接受ECMO的45例患者。结果：只有28.9%的ECMO患者在入院后18天（IQR 12-31）和开始ECMO后10.5天（IQR 1-28）接受了院内姑息治疗咨询。1年死亡率很高，44%在住院期间死亡，另外13%在接下来的一年内死亡。患者住院时间较长（平均住院时间：39天，IQR 19-89），气管切开术（53%）和肾脏替代治疗（60%）的比例较高。大多数临终病例在ECMO期间停止了维持生命的治疗，但只有53%的患者有完整的生前遗嘱。结论：我们的研究强调了早期开始姑息治疗咨询的必要性，以加强症状管理，提前护理计划，护理人员支持和ECMO患者及其家属的生活质量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMJ Supportive & Palliative Care Medicine-Medicine (miscellaneous)

CiteScore

4.60

自引率

7.40%

发文量

170

期刊介绍： Published quarterly in print and continuously online, BMJ Supportive & Palliative Care aims to connect many disciplines and specialties throughout the world by providing high quality, clinically relevant research, reviews, comment, information and news of international importance. We hold an inclusive view of supportive and palliative care research and we are able to call on expertise to critique the whole range of methodologies within the subject, including those working in transitional research, clinical trials, epidemiology, behavioural sciences, ethics and health service research. Articles with relevance to clinical practice and clinical service development will be considered for publication. In an international context, many different categories of clinician and healthcare workers do clinical work associated with palliative medicine, specialist or generalist palliative care, supportive care, psychosocial-oncology and end of life care. We wish to engage many specialties, not only those traditionally associated with supportive and palliative care. We hope to extend the readership to doctors, nurses, other healthcare workers and researchers in medical and surgical specialties, including but not limited to cardiology, gastroenterology, geriatrics, neurology, oncology, paediatrics, primary care, psychiatry, psychology, renal medicine, respiratory medicine.