Abstract 18831: Utilization of Palliative Care Consultation During Therapeutic Hypothermia Following Cardiac Arrest
Background: Palliative care (PC) is integral in the care of patients with advanced medical illnesses. The significant morbidity and mortality associated with therapeutic hypothermia (TH) after cardiac arrest calls for improved end-of-life care. The goal of this descriptive study was to review our institutional experience with PC consultation in this critically ill population.
Methods: We conducted a retrospective study of 319 consecutive patients undergoing TH post-cardiac arrest at Vanderbilt University Medical Center from May 2007 to April 2014. We compared intensive care unit characteristics of patients who received PC consultation (n=125) to those who did not (n=194). We performed Wilcoxon rank sum analyses for time on mechanical ventilation and vasopressor support and Pearson chi-square analyses for inpatient mortality, placement of a Do Not Resuscitate (DNR) order and withdrawal of life support.
Results: The number of TH patients and PC consultations in this population increased over time (Figure 1). In the overall cohort, the mean age was 57.3 years (+/- 15.3), and 61% of patients were male. The PC group was mechanically ventilated longer (mean 5.18 vs. 3.45 days, p<0.001) with a trend toward longer vasopressor support (47.2 vs. 40.8 hours, p=0.055) and higher inpatient mortality (68% vs. 49%, p=0.001). PC consultation was also associated with a higher frequency of DNR order placement during hospitalization (75% vs. 36%, p<0.001) and increased frequency of withdrawal of life support (64% vs. 42%, p<0.001).
Conclusions: In our TH population, PC consultation increased over time, corresponding to our institution’s expansion of staffing, opening of a PC unit and integration of this service into our published TH protocol. Future studies may delineate the appropriate patient selection for PC consultation to better facilitate goals of care and medical decision-making.
Author Disclosures: E.K. Zern: None. M.N. Young: None. M. Xu: None. T.S. Triana: None. B.B. Holmes: None. N. Borges: None. J.A. McPherson: None. M.B. Karlekar: None.
- © 2015 by American Heart Association, Inc.