护理需要静脉动脉体外膜氧合的患者:上游姑息治疗能否有所作为?

Katie Stevens, Samuel R Anandan, Husneara Rahman, Sima Parikh, An Gao Leung, Andrea Benintendi, Katlynn M Van Ogtrop, Alyssa Stancavage, Christopher J Magalee, Frank Manetta, Christina Saikus, Santiago Lopez
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引用次数: 0

摘要

目的:姑息治疗咨询与需要静脉-动脉体外膜氧合(VA-ECMO)的患者息息相关;但支持其价值的证据有限。针对这一人群,我们比较了心胸外科(CT)与老年医学和姑息医学(GaP)合作前后的住院时间(LOS)(主要结果)、操作指标和护理目标(GOC)频率:方法:对2019-2021年间入住一家四级中心、需要VA-ECMO并接受GaP会诊的患者(18岁以上)进行回顾性病历审查。结果:120 名患者符合纳入标准,其中 64 名患者(18 岁以上)接受了 GaP 会诊:120名患者符合纳入标准,64人(53.3%)接受了GaP会诊。在人口统计学和插入状态(急诊与择期)方面未观察到差异。2019年、2020年和2021年的GaP就诊天数中位数(IQR)分别为6.5(4.0-14.5)、5.0(2.0-11.0)和3.0(2.0-5.0)(P = .006)。2019年、2020年和2021年从插入到就诊的中位天数分别为6.0(4.0-20.0)、3.0(1.0-6.0)和2.0(1.0-4.0)(P = .003)。在存活患者中,3年病程的中位生存期没有统计学差异。在过期患者中,2019 年、2020 年和 2021 年的中位生存期(IQR)分别为 28.5 天(23.0-40.0)、12.0 天(8.0-14.0)和 11.0 天(5.0-17.0)(P = .013)。GaP未就诊的患者中,有8例(14.3%)记录了GOC笔记,而就诊患者中有42例(65.6%)记录了GOC笔记。死亡率相似(53.6% vs 53.1% [GaP]):结论:对于使用 VA-ECMO 的患者,早期姑息治疗咨询可改善住院时间和 GOC 发生率。我们建议各医疗机构在实施机械循环支持时考虑早期姑息治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Caring for Patients Requiring Venous Arterial Extracorporeal Membrane Oxygenation: Can Upstream Palliative Care Make a Difference?

Objective: Palliative care consultation is relevant for patients requiring Venous-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO); however, evidence is limited to support its value. For this population, we compared length of stay (LOS) (primary outcome), operational metrics and goals of care (GOC) frequency before and after a collaboration between cardiothoracic (CT) surgery and Geriatrics and Palliative Medicine (GaP).

Methods: Retrospective chart review of patients (18+) admitted to a quaternary center that required VA-ECMO between 2019-2021 and received GaP consultation. Demographics, LOS, times to consult, illness severity, GOC, and outcomes were analyzed.

Results: 120 patients met inclusion criteria and 64 (53.3%) had GaP consultation. No differences were observed regarding demographics and insertion status (emergent vs elective). Median (IQR) days to GaP consult for 2019, 2020 and 2021 were 6.5 (4.0-14.5), 5.0 (2.0-11.0) and 3.0 (2.0-5.0), respectively (P = .006). Median days from insertion to consult for 2019, 2020 and 2021 were 6.0 (4.0-20.0), 3.0 (1.0-6.0) and 2.0 (1.0-4.0) (P = .003). Among survivors, over the 3-year course, median LOS was not statistically different. Between expired patients, median (IQR) LOS for 2019, 2020, and 2021 was 28.5 (23.0-40.0), 12.0 (8.0-14.0), 11.0 (5.0-17.0) days (P = .013). For patients not seen by GaP, 8 (14.3%) GOC notes were documented, compared with 42 (65.6%) for patients seen. Mortality was similar (53.6% vs 53.1% [GaP]).

Conclusion: For patient on VA-ECMO, early GaP consultation may improve hospital LOS and GOC rates. We suggest organizations consider early palliative integration when instituting mechanical circulatory support.

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