Hostname: page-component-76fb5796d-dfsvx Total loading time: 0 Render date: 2024-04-25T10:23:26.943Z Has data issue: false hasContentIssue false
  • English
  • Français

Extracorporeal membrane oxygenation and paediatric palliative care in an ICU

Published online by Cambridge University Press:  24 October 2022

Claudia Delgado-Corcoran Open the ORCID record for Claudia Delgado-Corcoran [Opens in a new window] ,
Sarah E. Wawrzynski ,
Brian Flaherty ,
Brandon Kirkland ,
Stephanie Bodily ,
Dominic Moore ,
Lawrence J. Cook  and
Lenora M. Olson
Claudia Delgado-Corcoran*
Affiliation:
Division of Critical Care, Department of Pediatrics, University of Utah, 295 Chipeta Way, PO BOX 581289, Salt Lake City, UT, USA Division of Pediatric Palliative Care, Department of Pediatrics, University of Utah, 100 N. Mario Capecchi Dr. Salt Lake City, UT, USA
Sarah E. Wawrzynski
Affiliation:
Pediatric Critical Care Services, Primary Children’s Hospital, Intermountain Healthcare, 100 N. Mario Capecchi Dr. Salt Lake City, UT, USA University of Utah, College of Nursing, 10 S 2000 E, Salt Lake City, UT, USA
Brian Flaherty
Affiliation:
Division of Critical Care, Department of Pediatrics, University of Utah, 295 Chipeta Way, PO BOX 581289, Salt Lake City, UT, USA
Brandon Kirkland
Affiliation:
Division of Critical Care, Department of Pediatrics, University of Utah, 295 Chipeta Way, PO BOX 581289, Salt Lake City, UT, USA
Stephanie Bodily
Affiliation:
Pediatric Critical Care Services, Primary Children’s Hospital, Intermountain Healthcare, 100 N. Mario Capecchi Dr. Salt Lake City, UT, USA
Dominic Moore
Affiliation:
Division of Critical Care, Department of Pediatrics, University of Utah, 295 Chipeta Way, PO BOX 581289, Salt Lake City, UT, USA Division of Pediatric Palliative Care, Department of Pediatrics, University of Utah, 100 N. Mario Capecchi Dr. Salt Lake City, UT, USA
Lawrence J. Cook
Affiliation:
Division of Critical Care, Department of Pediatrics, University of Utah, 295 Chipeta Way, PO BOX 581289, Salt Lake City, UT, USA
Lenora M. Olson
Affiliation:
Salt Lake City, UT, USA
*
Author for correspondence: Dr C. Delgado-Corcoran, MD, MPH, University of Utah, 295 Chipeta Way, PO BOX 581289, Salt Lake City, UT 84108, USA. Tel: +1 801-599-0085; Fax: +1 801-662-2469. E-mail: Claudia.delgado@hsc.utah.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

Compare rates, clinical characteristics, and outcomes of paediatric palliative care consultation in children supported on extracorporeal membrane oxygenation admitted to a single-centre 16-bed cardiac or a 28-bed paediatric ICU.

Methods:

Retrospective review of clinical characteristics and outcomes of children (aged 0–21 years) supported on extracorporeal membrane oxygenation between January, 2017 and December, 2019 compared by palliative care consultation.

Measurements and results:

One hundred children (N = 100) were supported with extracorporeal membrane oxygenation; 19% received a palliative care consult. Compared to non-consulted children, consulted children had higher disease severity measured by higher complex chronic conditions at the end of extracorporeal membrane oxygenation hospitalisation (5 versus. 3; p < 0.001), longer hospital length of stay (92 days versus 19 days; p < 0.001), and higher use of life-sustaining therapies after decannulation (79% versus 23%; p < 0.001). Consultations occurred mainly for longitudinal psychosocial-spiritual support after patient survived device deployment with a median of 27 days after cannulation. Most children died in the ICU after withdrawal of life-sustaining therapies regardless of consultation status. Over two-thirds of the 44 deaths (84%; n = 37) occurred during extracorporeal membrane oxygenation hospitalisation.

Conclusions:

Palliative care consultation was rare showing that palliative care consultation was not viewed as an acute need and only considered when the clinical course became protracted. As a result, there are missed opportunities to involve palliative care earlier and more frequently in the care of extracorporeal membrane survivors and non-survivors and their families.

Keywords

Extracorporeal membrane oxygenationpaediatricsPalliative carelongitudinal supportbereavementsurvivors and non-survivors
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 10 , October 2023 , pp. 1846 - 1852
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Di Nardo, M, MacLaren, G, Marano, M, et al. ECLS in pediatric cardiac patients. Front Pediatr 2016; 4: 109.10.3389/fped.2016.00109CrossRefGoogle ScholarPubMed
Laussen, PC, Guerguerian, AM. Establishing and sustaining an ECPR program. Front Pediatr 2018; 6: 152.10.3389/fped.2018.00152CrossRefGoogle ScholarPubMed
Coleman, RD, Goldman, J, Moffett, B, et al. Extracorporeal membrane oxygenation mortality in high-risk populations: an analysis of the pediatric health information system database. ASAIO J 2020; 66: 327–331.10.1097/MAT.0000000000001002CrossRefGoogle ScholarPubMed
Lawrence, AE, Sebastião, YV, Deans, KJ, et al. Beyond survival: readmissions and late mortality in pediatric ECMO survivors. J Pediatr Surg 2021; 56: 187–191.CrossRefGoogle ScholarPubMed
IJsselstijn, H, Hunfeld, M, Schiller, RM, et al. Improving long-term outcomes after extracorporeal membrane oxygenation: from observational follow-up programs toward risk stratification. Front Pediatr 2018; 6: 1776.10.3389/fped.2018.00177CrossRefGoogle ScholarPubMed
Wray, J, Kakat, S, Brown, K, O'Callaghan, M, et al. Childhood extracorporeal membrane oxygenation survivors: parents highlight need for structured follow-up and support after hospital discharge. Pediatr Crit Care Med 2020; 21: 461–468.10.1097/PCC.0000000000002253CrossRefGoogle ScholarPubMed
DellaVolpe, J, Barbaro, RP, Cannon, JW, et al. Joint society of critical care medicine- extracorporeal life support organization task force position paper on the role of the intensivist in the initiation and management of extracorporeal membrane oxygenation. Crit Care Med 2020; 48: 838–846.10.1097/CCM.0000000000004330CrossRefGoogle ScholarPubMed
Friebert, S, Osenga, K, Pediatric palliative care referral criteria. Pediatric palliative care referral criteria Center to Advance Palliative Care 2009.Google Scholar
Kaye, EC, Weaver, MS, DeWitt, LH, et al. The impact of specialty palliative care in pediatric oncology: a systematic review . AAHPM Research Committee. J Pain Symptom Manage 2021; 61: 1060–1079.10.1016/j.jpainsymman.2020.12.003CrossRefGoogle ScholarPubMed
Temel, JS, Greer, JA, El-Jawahri, A, et al. Effects of early integrated palliative care in patients with lung and GI cancer . A randomized clinical trial.J Clin Oncol 2017; 35: 834–841.CrossRefGoogle ScholarPubMed
El-Jawahri, A, Greer, JA, Pirl, WF, et al. Effects of early integrated palliative care on caregivers of patients with lung and gastrointestinal cancer: a randomized clinical trial. Oncologist 2017; 22: 1528–1534.10.1634/theoncologist.2017-0227CrossRefGoogle ScholarPubMed
Keele, L, Keenan, HT, Sheetz, J, et al. Differences in characteristics of dying children who receive and do not receive palliative care. Pediatrics 2013; 132: 72–78.CrossRefGoogle Scholar
Vern-Gross, TZ, Lam, CG, Graff, Z, et al. Patterns of end-of-life care in children with advanced solid tumor malignancies enrolled on a palliative care service. J Pain Symptom Manage 2015; 50: 305–312.10.1016/j.jpainsymman.2015.03.008CrossRefGoogle ScholarPubMed
Richards, Ca, Starks, H, O’ Connor, MR, et al. When and why do neonatal and pediatric critical care physicians consult palliative care? Am J Hosp Palliat Care 2018; 35: 840–846.10.1177/1049909117739853CrossRefGoogle ScholarPubMed
Ciriello, AG, Dizon, ZB, October, TW. Speaking a different language: a qualitative analysis comparing language of palliative care and pediatric intensive care unit physicians. Am J Hosp Palliat Care 2018; 35: 384–389.CrossRefGoogle Scholar
Friedrichsdorf, SJ, Postier, A, Dreyfus, J, et al. Improved quality of life at end of life related to home-based palliative care in children with cancer. J Palliat Med 2015; 18: 143–150.10.1089/jpm.2014.0285CrossRefGoogle ScholarPubMed
Zalenski, RJ, Jones, SS, Courage, C, et al. Impact of palliative care screening and consultation in the ICU: a multihospital quality improvement project. J Pain Symptom Manage 2017; 53: 5–12.e3.10.1016/j.jpainsymman.2016.08.003CrossRefGoogle ScholarPubMed
Trowbridge, A, Walter, JK, McConathey, E, et al. Modes of death within a children’s hospital. Pediatrics 2018; 142: e20174182.10.1542/peds.2017-4182CrossRefGoogle ScholarPubMed
Delgado-Corcoran, C, Wawrzynski, SE, Bennett, EE, et al. Palliative care in children with heart disease treated in an ICU. Pediatr Crit Care Med 2020; 21: 423–429.10.1097/PCC.0000000000002271CrossRefGoogle Scholar
O'Keefe, S, Maddux, AB, Bennett, KS, et al. Variation in pediatric palliative care allocation among critically ill children in the United States. Pediatr Crit Care Med 2021; 22: 462–473.10.1097/PCC.0000000000002603CrossRefGoogle ScholarPubMed
Lutmer, JE, Humphrey, L, Kempton, TM, et al. Screening criteria improve access to palliative care in the PICU. Pediatr Crit Care Med 2016; 17: e335–e342.10.1097/PCC.0000000000000848CrossRefGoogle ScholarPubMed
Humphrey, L, Schlegel, A, Seabrook, R, et al. Trigger criteria to increase appropriate palliative care consultation in the neonatal intensive care unit. Pediatr Qual Saf 2019; 4: e129.10.1097/pq9.0000000000000129CrossRefGoogle ScholarPubMed
Doorebos, AZ, Starks, H, Bourget, E, et al. Examining palliative care team involvement in automatic consultations for children on extracorporeal life support in the pediatric intensive care unit. J Palliat Med 2013; 16: 492–495.10.1089/jpm.2012.0536CrossRefGoogle Scholar
Maratta, C, Potera, RM, van Leeuwen, G, et al. Extracorporeal life support organization (ELSO): 2020 pediatric respiratory ELSO guideline. ASAIO J 2020; 66: 975–979.10.1097/MAT.0000000000001223CrossRefGoogle ScholarPubMed
Brown, G, Moynihan, K, Deatrick, K, et al. Extracorporeal life support organization (ELSO): guidelines for pediatric cardiac failure. Asaio J 2021; 67: 463–475.10.1097/MAT.0000000000001431CrossRefGoogle ScholarPubMed
Feudtner, C, Feinstein, JA, Zhong, W, et al. Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation. BMC Pediatr 2014; 14: 199.10.1186/1471-2431-14-199CrossRefGoogle ScholarPubMed
Costello, JM, Mussatto, K, Cassedy, A, et al. Prediction by clinicians of quality of life for children and adolescents with cardiac disease. J Pediatr 2015; 166: 679–83.e2.10.1016/j.jpeds.2014.11.061CrossRefGoogle ScholarPubMed
Morell, E, Thompson, J, Rajagopal, S, et al. Congenital cardiothoracic surgeons and palliative care: a national survey study. J Palliat Care 2021; 36: 17–21.10.1177/0825859719874765CrossRefGoogle ScholarPubMed
Balkin, EM, Sleeper, LA, Kirkpatrick, JN, et al. Physician perspectives on palliative care for children with advanced heart disease: a comparison between pediatric cardiology and palliative care physicians. J Palliat Med 2018; 21: 773–779.10.1089/jpm.2017.0612CrossRefGoogle ScholarPubMed
Balkin, EM, Kirkpatrick, JN, Kaufman, B, et al. Pediatric cardiology provider attitudes about palliative care: a multicenter survey study. Pediatr Cardiol 2017; 38: 1324–1331.10.1007/s00246-017-1663-0CrossRefGoogle ScholarPubMed
Delgado-Corcoran, C, Wawrzynski, SE, Mansfield, KJ, et al. An automatic pediatric palliative care consultation for children supported on extracorporeal membrane oxygenation: A survey of perceived benefits and barriers [published online ahead of print, 2022 Mar 18]. J Palliat Medic 2022. DOI 10.1089/jpm.2021.0452.Google ScholarPubMed
Mulaikal, TA, Nakagawa, S, Prager, KM. Extracorporeal membrane oxygenation bridge to no recovery. Circulation 2019; 139: 428–430.10.1161/CIRCULATIONAHA.118.036304CrossRefGoogle ScholarPubMed
Makdisi, T, Makdisi, G. Ethical challenges in extra corporeal membrane oxygenation use. Ann Palliat Med 2017; 6: S128–S131.10.21037/apm.2017.03.11CrossRefGoogle ScholarPubMed
Curley, MA, Meyer, EC. Parental experience of highly technical therapy: survivors and nonsurvivors of extracorporeal membrane oxygenation support. Pediatr Crit Care Med 2003; 4: 214–219.10.1097/01.PCC.0000043915.79848.8DCrossRefGoogle ScholarPubMed
Moynihan, KM, Purol, N, Alexander, PMA, et al. A communication guide for pediatric extracorporeal membrane oxygenation. Pediatr Crit Care Med 2021; 22: 832–841.10.1097/PCC.0000000000002758CrossRefGoogle ScholarPubMed
Hancock, HS, Pituch, K, Uzark, K, et al. A randomised trial of early palliative care for maternal stress in infants prenatally diagnosed with single-ventricle heart disease. Cardiol Young 2018; 28: 561–570.10.1017/S1047951117002761CrossRefGoogle ScholarPubMed
Marcus, KL, Santos, G, Ciapponi, A, et al. Impact of specialized pediatric palliative care: a systematic review. J Pain Symptom Manage 2020; 59: 339–364.10.1016/j.jpainsymman.2019.08.005CrossRefGoogle ScholarPubMed
Nelson, JE, Curtis, JR, Mulkerin, C, et al. Improving palliative care in the ICU (IPAL-ICU) project advisory board. choosing and using screening criteria for palliative care consultation in the ICU: a report from the improving palliative care in the ICU (IPAL-ICU) advisory board. Crit Care Med 2013; 41: 2318–2327.10.1097/CCM.0b013e31828cf12cCrossRefGoogle ScholarPubMed
Boss, R, Nelson, J, Weissman, D, et al. Integrating palliative care into the PICU: a report from the improving palliative care in the ICU advisory board. Pediatr Crit Care Med 2014; 15: 762–767.CrossRefGoogle Scholar
Tramm, R, Ilic, D, Murphy, K, et al. Experience and needs of family members of patients treated with extracorporeal membrane oxygenation. J Clin Nurs 2017; 26: 1657–1668.10.1111/jocn.13566CrossRefGoogle ScholarPubMed
Meenaghan, SM, Nugent, GM, Dee, EC, et al. Health-related quality of life in pediatric cardiac patients after extracorporeal life support. Pediatr Cardiol 2021; 42: 1433–1441.10.1007/s00246-021-02629-7CrossRefGoogle ScholarPubMed
Elias, MD, Achuff, BJ, Ittenbach, RF, et al. Long-term outcomes of pediatric cardiac patients supported by extracorporeal membrane oxygenation. Pediatr Crit Care Med 2017; 18: 787–794.10.1097/PCC.0000000000001227CrossRefGoogle ScholarPubMed
Garcia Guerra, G, Robertson, CM, Alton, GY, et al. Western canadian complex pediatric therapies follow-up group health-related quality of life in pediatric cardiac extracorporeal life support survivors. Pediatr Crit Care Med 2014; 15: 720–727.10.1097/PCC.0000000000000212CrossRefGoogle ScholarPubMed
Feudtner, C, Nye, RT, Boyden, JY, et al. Association between children with life-threatening conditions and their parents' and siblings' mental and physical health. JAMA Netw Open 2021; 4: e2137250.10.1001/jamanetworkopen.2021.37250CrossRefGoogle ScholarPubMed
Fernando, SM, Qureshi, D, Tanuseputro, P, et al. Mortality and costs following extracorporeal membrane oxygenation in critically ill adults: a population-based cohort study. Intens Care Med 2019; 45: 1580–1589.10.1007/s00134-019-05766-zCrossRefGoogle ScholarPubMed
Sealey, M, Breen, LJ, O'Connor, M, et al. A scoping review of bereavement risk assessment measures: implications for palliative care. Palliat Med 2015; 29: 577–578.10.1177/0269216315576262CrossRefGoogle ScholarPubMed
Grunauer, M, Mikesell, C, Bustamante, G, PICU-MIC Research Group, et al. Availability and quality of grief and bereavement care in pediatric intensive care units around the world, opportunities for improvement. Front Pediatr 2021; 9: 742916.CrossRefGoogle ScholarPubMed
Machado, DS, Hollander, SA, Murray, J, Philip, J, et al. Ventricular assist device deactivation in children: preparedness planning and procedural checklist. J Heart Lung Transplant 2019; 38: 1116–1118.10.1016/j.healun.2019.06.013CrossRefGoogle ScholarPubMed
Bogetz, JF, Ullrich, CK, Berry, JG. Pediatric hospital care for children with life-threatening illness and the role of palliative care. Pediatr Clin North Am 2014; 61: 719–733.10.1016/j.pcl.2014.05.002CrossRefGoogle ScholarPubMed
Goloff, N, Joy, BF. A part of the team: the changing role of palliative care in congenital heart disease. Prog Pediatr Cardiol 2018; 48: 59–62.CrossRefGoogle Scholar