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Futility in the paediatric cardiac ICU

Published online by Cambridge University Press:  24 July 2020

Michael P. Fundora*
Affiliation:
Children’s Healthcare of Atlanta, Department of Pediatrics, Division of Cardiology, Emory University, Atlanta, GA, USA
Zahidee Rodriguez
Affiliation:
Children’s Healthcare of Atlanta, Department of Pediatrics, Division of Cardiology, Emory University, Atlanta, GA, USA
William T. Mahle
Affiliation:
Children’s Healthcare of Atlanta, Department of Pediatrics, Division of Cardiology, Emory University, Atlanta, GA, USA
*
Author for correspondence: M. P. Fundora, MD, Assistant Professor of Pediatrics, Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University School of Medicine, 1405 Clifton Road NE, Atlanta, GA30322-1062, USA. Tel: +404-785-1886; Fax: +404-785-6021. E-mail: Michael.Fundora@emory.edu

Abstract

Introduction:

Studies have suggested 5–20% of paediatric ICU patients may receive care felt to be futile. No data exists on the prevalence and impact of futile care in the Paediatric Cardiac ICU. The aim is to determine the prevalence and economic impact of futile care.

Materials and method:

Retrospective cohort of patients with congenital cardiac disease 0–21 years old, with length of stay >30 days and died (2015–2018). Documentation of futility by the medical team was retrospectively and independently reviewed.

Results:

Of the 127 deaths during the study period, 51 (40%) had hospitalisation >30 days, 13 (25%) had received futile care and 26 (51%) withdrew life-sustaining treatment. Futile care comprised 0.69% of total patient days with no difference in charges from patients not receiving futile care. There was no difference in insurance, single motherhood, education, income, poverty, or unemployment in families continuing futile care or electing withdrawal of life-sustaining treatment. Black families were less likely than White families to elect for withdrawal (p = 0.01), and Hispanic families were more likely to continue futile care than non-Hispanics (p = 0.044).

Conclusions:

This is the first study to examine the impact of futile care and characteristics in the paediatric cardiac ICU. Black families were less likely to elect for withdrawal, while Hispanic families more likely to continue futile care. Futile care comprised 0.69% of bed days and little burden on resources. Cultural factors should be investigated to better support families through end-of-life decisions.

Type
Original Article
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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