Primary and Specialist-Level Palliative Care during the spring 2020 COVID-19 Surge: A Single-Center Experience in the Bronx.
Kaleena Zhang, Marc Shi, Tia Powell and 1 others
PMID 34313146WHAT IT FOUND
Only 4 of 162 mechanically ventilated patients in this Bronx surge cohort survived documented CPR, and none over 64 survived.
Patients with palliative care consults had more code status changes but also higher mortality and longer ventilation.
Key findings
01Among mechanically ventilated patients, only 4 of 162 documented CPR attempts resulted in survival (2.5%), and no patient above 64 survived.
02Patients with a palliative care consult had more code status changes (56.6% vs 18.6%) but also higher mortality (81% vs 68%) and longer average mechanical ventilation (14.9 vs 8.3 days).
03Only about half of patients had a palliative care consult, and the average time from admission to consult was 9 days.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This looked back at charts from one academic medical center in the Bronx during the early spring 2020 surge, so it may not match patients or care now. The study cannot show that palliative care caused code status changes because consults were not randomly assigned, and patients who received consults may have differed in severity or prognosis. CPR outcomes only include documented attempts; during the surge, documentation requirements were waived and records were sometimes incomplete. It is unknown how many clinicians used the communication scripts, so the study cannot compare scripts with formal palliative care consultation well. Patients were mechanically ventilated and had many comorbidities, so results may not apply to less severe illness.
Declared interests
The authors declared no potential conflicts of interest. They disclosed financial support from the National Center for Advancing Translational Sciences.
The easy way to misread this
Do not conclude that CPR is futile for all ventilated patients or that palliative care consults cause code status changes. The survival figures are from one early-pandemic cohort, and the palliative care link is confounded because consults were not randomly assigned and may have happened in patients already closer to dying.