A Retrospective Cohort Study of the Role of Palliative Care Consultation for Patients on Extracorporeal Membrane Oxygenation

Abstract

Background

Extracorporeal membrane oxygenation (ECMO) serves as a critical intervention for patients with severe cardiac and pulmonary dysfunction. Given the high rates of mortality and morbidity, as well as the impact on families, palliative care (PC) integration is recommended. We aimed to examine the indications and outcomes of ECMO patients at a tertiary care hospital and evaluate the impact of PC consultation on patient outcomes.

Methods

We conducted a retrospective cohort study of 306 patients cannulated for venovenous (VV) or venoarterial (VA) ECMO from January 2020 to December 2022. We analyzed demographics, ECMO indications, and outcomes, comparing those who received PC consultations with those who did not.

Results

Of the 306 patients analyzed, 220 were on VA-ECMO and 86 on VV-ECMO. The overall in-hospital mortality rate was 49%. Patients on VV-ECMO had longer ECMO durations (8 vs 4 days) and hospital stays (31 vs 16 days, P < 0.001) than patients on VA-ECMO. PC consultations were associated with increased ECMO duration and hospital stay in both groups (P < 0.001). Mortality among patients who received PC consultations was not statistically different from those who did not (P = 0.68). Notably, patients with obesity on VA-ECMO had 2.3 times higher odds of in-hospital death (P = 0.027).

Conclusion

PC consultation is integral in managing patients on ECMO, focusing on holistic support for patients and their families. Further prospective studies are warranted to explore the psychosocial benefits of PC for patients on ECMO and their family members.

Keywords

ECMO palliative care serious illness care COVID-19

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