Pediatric Cardiac Critical Care Transport and Palliative Care: A Case Series

Area of Science:

• Pediatric Critical Care Medicine
• Palliative Care
• Pediatric Cardiology

Background:

• Pediatric cardiac intensive care units (CVICU) manage technology-dependent children with complex chronic conditions.
• Families of terminally ill children may seek end-of-life care outside the hospital setting.
• Limited data exists on home transports for terminal extubation in this population.

Purpose of the Study:

• To describe the experience of a single center with home transports for terminal extubation.
• To evaluate the feasibility of providing critical care during transport for end-of-life care at home.
• To highlight the coordination required for successful out-of-hospital death for pediatric cardiac patients.

Main Methods:

• Retrospective review of 3 pediatric cardiac intensive care patients transported home for terminal extubation between 2014-2018.
• Involved multidisciplinary team meetings to establish goals of care and coordinate with home palliative care and hospice services.
• Detailed planning for life support during transport and addressing logistical challenges of home environment.

Main Results:

• Three pediatric patients (ages 7 months, 9 months, 19 years) with complex conditions underwent home transport for terminal extubation.
• All patients required highly trained teams for life support during transport due to unstable medical conditions.
• Coordination with home palliative care and community resources was essential due to access difficulties.

Conclusions:

• Home transport for terminal extubation is an infrequent but feasible option for pediatric cardiac critical care patients.
• This practice supports families seeking end-of-life care outside the hospital for technology-dependent children.
• Development of formal programs for end-of-life critical care transports is warranted.