The Use of Palliative Care Consults During Extracorporeal Membrane Oxygenation: A Multicenter Observational Study.

Abstract

Background: Palliative care can help alleviate the suffering of a person as they face a serious life-threatening disease. Extracorporeal membrane oxygenation (ECMO) supports patients who have severe cardiac or respiratory failure; however, there is a mortality rate of roughly 50%. Despite this, the role of palliative care remains poorly characterized. Objectives: To characterize the use of palliative care among patients on venovenous ECMO (VV-ECMO). Design: A retrospective cohort study was performed and included patients supported by VV-ECMO at all four ECMO centers in Minnesota, USA. Variables associated with palliative care consultations (PCCs) were collected, stratified, and compared across protocols. Results: Of the 420 patients in this study, 230 patients (54.8%) received a PCC during their admission. Individuals who received a PCC were significantly less likely to survive to discharge (52.6%) compared to those who did not receive a PCC (72.6%; p value <0.001). Centers 1 and 2 had an automatic palliative consult included in the VV-ECMO electronic health record (EHR) order set, whereas Centers 3 and 4 did not. Center 1 had the highest PCC rate of 81.6%, followed by Center 2 with 49.4%. In comparison, Centers 3 and 4 had significantly lower PCC rates of 36.9% and 29.7%, respectively (χ² = 81.92, p value <0.0001). Conclusions: In this study we found a majority of patients on VV-ECMO received a PCC. However, the absence of her-embedded PCC was associated with a significantly reduced rate of PCCs.