The Role of Palliative Care Consultation in Withdrawal of Life-Sustaining Treatment among ICU Patients Receiving Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO): A Retrospective Case-Control Study.
Gabriel Patarroyo-Aponte, Saeed Shoar, Deptmer M Ashley and 10 others
PMID 37117039WHAT IT FOUND
Patients on lung support who received palliative care consultations had significantly longer ICU stays and treatment durations than those who did not.
However, the reasons for withdrawing life support, primarily futility and surrogate wishes, did not differ between the groups.
Key findings
01The average duration of ICU stay was significantly longer in patients receiving palliative care consultation (40.3 days) than in those without (27.8 days).
02The average duration of VV-ECMO treatment was significantly longer in patients receiving palliative care consultation (31.9 days) than in those without (18.6 days).
03The frequency of life supporting measures and the underlying reasons for withdrawal of life-sustaining treatment did not significantly differ between the two groups.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study is retrospective, so it cannot establish causality or account for all factors influencing the decision to withdraw life support. Data was lacking on why palliative care consultation was underutilized for some patients with poor prognosis. The study was conducted in a single hospital, limiting generalizability to other settings. The findings apply only to patients on VV-ECMO and not to those on VA-ECMO. The association between PCC and longer treatment duration may reflect confounding by indication, where patients with more complex or prolonged courses are more likely to receive PCC.
Declared interests
The authors declared no potential conflicts of interest.
The easy way to misread this
Do not conclude that palliative care consultation causes longer ICU stays or delays in withdrawal of life support. The association may be due to confounding by indication, where patients who are sicker or have more complex care needs are more likely to receive palliative care consultation and also have longer treatment durations.