Palliative Care Referral Patterns and Implications for Standardization in Cardiac ICU

Area of Science:

• Pediatric Cardiology
• Palliative Care Medicine
• Intensive Care Medicine

Background:

• Pediatric palliative care (PPC) is recognized as beneficial for medically complex children.
• Historically, PPC involvement has been inconsistent and often delayed in pediatric intensive care settings.
• Increased awareness of PPC in cardiovascular intensive care units (CVICUs) necessitates investigation into its utilization for dying patients.

Purpose of the Study:

• To investigate the frequency and timeliness of PPC referral for pediatric patients who died in the ICU.
• To examine the association between PPC and do-not-resuscitate (DNR) discussions and cardiopulmonary resuscitation (CPR) on the day of death (DOD).

Main Methods:

• Retrospective study of pediatric cardiac patients who died in the ICU over a 5-year period.
• Data collected included PPC presence and timing, interventions, therapies, CPR status, and DNR discussions.
• Analysis compared outcomes for patients with and without PPC involvement.

Main Results:

• PPC involvement occurred in 74% (40/54) of pediatric cardiac patients who died in the ICU.
• Of patients without PPC, 79% met criteria for PPC referral based on established guidelines.
• PPC patients were significantly more likely to have DNR discussions (63% vs 14%, p=0.0011), both on DOD and prior to DOD.
• PPC involvement did not significantly affect the likelihood of CPR on DOD (28% vs 43%, p=0.29).
• Initial PPC often occurred within a week or on the day of death.

Conclusions:

• PPC is frequently involved in the care of pediatric patients dying in the CVICU.
• Timeliness of PPC referral is often suboptimal, with many patients qualifying for earlier intervention.
• Standardizing patient identification, timing, and referral processes for PPC can enhance its efficacy in CVICUs.