Provider Perceptions of Outcomes in the Pediatric Cardiac Intensive Care Unit

Area of Science:

• Pediatric Cardiology
• Intensive Care Medicine
• Medical Ethics

Background:

• Provider perceptions significantly influence decision-making regarding pediatric extracorporeal membrane oxygenation (ECMO) and cardiopulmonary resuscitation (CPR).
• Limited understanding exists regarding how provider role and experience shape these perceptions in the pediatric cardiac intensive care unit (PCICU).

Purpose of the Study:

• To explore and compare the risk tolerance and health-related quality of life (HRQoL) perceptions of multidisciplinary PCICU providers for ECMO and CPR.
• To investigate the influence of provider role and experience on these perceptions.

Main Methods:

• A survey was administered to 101 multidisciplinary PCICU providers assessing risk tolerance for complications and perceived impact on HRQoL for two patient scenarios: ECMO post-cardiac surgery and CPR for cardiac arrest.
• Responses were analyzed based on provider role (e.g., nurse, physician) and experience level.

Main Results:

• Providers demonstrated a higher tolerance for a 50% risk of death compared to other long-term morbidities associated with ECMO or CPR.
• Nurses exhibited lower risk tolerance for complications than attending physicians, with provider experience showing no significant impact.
• All surveyed providers underestimated the HRQoL scores of patients who survived these critical interventions.

Conclusions:

• PCICU providers are more willing to accept mortality risk than long-term morbidity and inaccurately predict patient HRQoL outcomes.
• Variability in risk tolerance and outcome prediction among team members highlights the need for improved communication and shared decision-making.
• Understanding these perceptual differences is crucial for enhancing patient-family communication, team dynamics, and clinical decision-making in the PCICU.