PMID- 33137423
OWN - NLM
STAT- MEDLINE
DCOM- 20210709
LR  - 20210709
IS  - 1873-6513 (Electronic)
IS  - 0885-3924 (Linking)
VI  - 61
IP  - 6
DP  - 2021 Jun
TI  - The Role of Palliative Care in Withdrawal of Venoarterial Extracorporeal Membrane 
      Oxygenation for Cardiogenic Shock.
PG  - 1139-1146
LID - S0885-3924(20)30856-3 [pii]
LID - 10.1016/j.jpainsymman.2020.10.027 [doi]
AB  - CONTEXT: As the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) 
      increases, decisions regarding withdrawal from VA-ECMO increase. OBJECTIVES: To 
      evaluate the clinical characteristics of patients withdrawn from VA-ECMO and the 
      role of palliative care consultation in the decision. METHODS: We retrospectively 
      reviewed adult patients with cardiogenic shock requiring VA-ECMO at our 
      institution, who were withdrawn from VA-ECMO between January 1, 2014 and May 31, 
      2019. The relationship between clinical characteristics and palliative care 
      visits was assessed, and documented reasons for withdrawal were identified. 
      RESULTS: Of 460 patients who received VA-ECMO, 91 deceased patients (19.8%) were 
      included. Forty-two patients (44.8%) had a palliative care consultation. The 
      median duration on VA-ECMO was 4.0 days (interquartile range 8.8), and it was 
      significantly longer for patients with palliative care consultation than those 
      without (8.8 days vs. 2.0 days, P < 0.001). Among those with palliative care 
      consultation, those with early consultation (within three days) had significantly 
      shorter duration of VA-ECMO compared with those with late consultation (7.6 days 
      vs. 13.5 days, t = 2.022, P = 0.008). Twenty-two (24.2%) had evidence of brain 
      injury, which was significantly associated with patient age, number of 
      comorbidities, duration of VA-ECMO, number of life-sustaining therapies, and 
      number of palliative care visits (Wilks lambda 0.8925, DF 5,121, P = 0.016). 
      Presence of brain injury was associated with fewer palliative care visits 
      (t = 2.82, P = 0.006). CONCLUSION: Shorter duration of VA-ECMO support and 
      presence of brain injury were associated with fewer palliative care visits. 
      Decisions around withdrawal of VA-ECMO support might be less complicated when 
      patient's medical conditions deteriorate quickly or when neurological prognosis 
      seems poor.
CI  - Copyright (c) 2020 American Academy of Hospice and Palliative Medicine. Published 
      by Elsevier Inc. All rights reserved.
FAU - Godfrey, Sarah
AU  - Godfrey S
AD  - Department of Medicine, Columbia University Irving Medical Center, New York, New 
      York, USA.
FAU - Sahoo, Aradhana
AU  - Sahoo A
AD  - Department of Medicine, Columbia University Irving Medical Center, New York, New 
      York, USA.
FAU - Sanchez, Joseph
AU  - Sanchez J
AD  - Department of Surgery, Northwestern University Feinberg School of Medicine, 
      Chicago, Illinois, USA.
FAU - Fried, Justin
AU  - Fried J
AD  - Department of Medicine, Columbia University Irving Medical Center, New York, New 
      York, USA; Division of Cardiology, Columbia University Irving Medical Center, New 
      York, New York, USA.
FAU - Masoumi, Amirali
AU  - Masoumi A
AD  - Department of Medicine, Columbia University Irving Medical Center, New York, New 
      York, USA; Division of Cardiology, Columbia University Irving Medical Center, New 
      York, New York, USA.
FAU - Brodie, Daniel
AU  - Brodie D
AD  - Department of Medicine, Columbia University Irving Medical Center, New York, New 
      York, USA; Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia 
      University Irving Medical Center, New York, New York, USA.
FAU - Takayama, Hiroo
AU  - Takayama H
AD  - Division of Cardiac, Vascular, and Thoracic Surgery, Columbia University Irving 
      Medical Center, New York, New York, USA.
FAU - Uriel, Nir
AU  - Uriel N
AD  - Department of Medicine, Columbia University Irving Medical Center, New York, New 
      York, USA; Division of Cardiology, Columbia University Irving Medical Center, New 
      York, New York, USA.
FAU - Takeda, Koji
AU  - Takeda K
AD  - Division of Cardiac, Vascular, and Thoracic Surgery, Columbia University Irving 
      Medical Center, New York, New York, USA.
FAU - Nakagawa, Shunichi
AU  - Nakagawa S
AD  - Department of Medicine, Columbia University Irving Medical Center, New York, New 
      York, USA; Adult Palliative Care Services, Columbia University Irving Medical 
      Center, New York, New York, USA. Electronic address: sn2573@cumc.columbia.edu.
LA  - eng
PT  - Journal Article
DEP - 20201101
PL  - United States
TA  - J Pain Symptom Manage
JT  - Journal of pain and symptom management
JID - 8605836
SB  - IM
MH  - Adult
MH  - *Extracorporeal Membrane Oxygenation
MH  - *Hospice and Palliative Care Nursing
MH  - Humans
MH  - Palliative Care
MH  - Retrospective Studies
MH  - Shock, Cardiogenic/therapy
OTO - NOTNLM
OT  - Cardiogenic shock
OT  - ECMO
OT  - end-of-life care
OT  - goals of care
OT  - heart failure
OT  - palliative care
EDAT- 2020/11/03 06:00
MHDA- 2021/07/10 06:00
CRDT- 2020/11/02 20:11
PHST- 2020/08/09 00:00 [received]
PHST- 2020/10/23 00:00 [revised]
PHST- 2020/10/26 00:00 [accepted]
PHST- 2020/11/03 06:00 [pubmed]
PHST- 2021/07/10 06:00 [medline]
PHST- 2020/11/02 20:11 [entrez]
AID - S0885-3924(20)30856-3 [pii]
AID - 10.1016/j.jpainsymman.2020.10.027 [doi]
PST - ppublish
SO  - J Pain Symptom Manage. 2021 Jun;61(6):1139-1146. doi: 
      10.1016/j.jpainsymman.2020.10.027. Epub 2020 Nov 1.