Palliative Care for Patients on Extracorporeal Membrane Oxygenation for COVID-19 Infection.
Anirudh Rao, Akram M Zaaqoq, In Guk Kang and 6 others
PMID 33685240WHAT IT FOUND
All 23 patients on ECMO for severe COVID-19 received palliative care within 48 hours, averaging 6.8 encounters.
Nine of 11 deaths followed comfort-focused goals changes, and all 6 patients aged 50 or older died.
Key findings
01All patients received palliative care consultation within 48 hours of ECMO cannulation, and patients or families averaged 6.8 palliative clinical encounters.
02Eleven of 23 patients died, and 9 of the 11 deaths followed a change in goals of care toward withdrawal of life-sustaining therapies and allowing natural death.
03All 6 patients aged 50 or older died, and patients older than 50 years had a shorter time from ECMO cannulation to death (time ratio 0.51, 95% CI 0.26 to 0.98, P<.05).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a retrospective case series of 23 patients at one hospital, so it describes what happened but cannot show whether palliative care changed outcomes. There was no comparison group of ECMO patients who did not receive palliative care consultation. The small cohort may have missed real differences between age groups, comorbidities, or types of palliative care actions and survival. The sample was mostly Hispanic, obese, and young, and the hospital had staff to provide palliative care to all ECMO patients, so results may not apply elsewhere. The age finding was based on 6 patients aged 50 or older, and the odds-of-death comparison was not statistically significant.
The easy way to misread this
Do not read the 48% mortality or palliative care involvement as evidence that palliative care improved outcomes. There was no comparison group, and the study was a small retrospective case series.