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

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.