Futility in the paediatric cardiac ICU
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Published on: April 7, 2023
Michael P Fundora1, Zahidee Rodriguez1, William T Mahle1
1Children's Healthcare of Atlanta, Department of Pediatrics, Division of Cardiology, Emory University, Atlanta, GA, USA.
Insights
Futile care occurred in 25% of long-stay pediatric cardiac ICU deaths, with no economic impact. Cultural factors influenced end-of-life decisions, with Black families less likely to withdraw life support and Hispanic families more likely to continue futile care.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Health Services Research
Background:
- Studies indicate 5-20% of pediatric ICU patients may receive futile care.
- No prior data exists on futile care prevalence in Pediatric Cardiac ICUs.
- This study addresses the prevalence and economic impact of futile care in this specific population.
Purpose of the Study:
- To determine the prevalence of futile care in pediatric cardiac intensive care units (ICUs).
- To assess the economic impact of futile care in pediatric cardiac ICUs.
- To identify demographic and cultural factors associated with futile care and end-of-life decisions.
Main Methods:
- Retrospective cohort study of congenital cardiac disease patients (0-21 years) with >30 days length of stay who died between 2015-2018.
- Independent retrospective review of medical team documentation of futility.
- Analysis of demographic and socioeconomic factors of families.
Main Results:
- Of 127 deaths, 51 (40%) had prolonged hospitalization (>30 days).
- Futile care was identified in 13 patients (25% of prolonged stays), comprising 0.69% of total patient days with no significant difference in charges.
- Black families were less likely to elect withdrawal of life-sustaining treatment (p=0.01), and Hispanic families were more likely to continue futile care (p=0.044).
Conclusions:
- This is the first study to examine futile care in the pediatric cardiac ICU.
- Cultural factors appear to influence end-of-life decisions, with observed disparities among racial and ethnic groups.
- Futile care had a minimal resource burden, highlighting the need to investigate cultural factors to support families.
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.
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