Enhancing Care in Cardiogenic Shock: Role of Palliative Care in Acute Cardiogenic Shock Through Destination Therapy

Despite advances in the management of cardiogenic shock (CS), morbidity and mortality in CS remain exceedingly high and one third of patients do not survive their admission. Palliative care (PC) is an interdisciplinary approach focussed on improving the quality of life of patients and families facing life-threatening illness. Rates of PC use in CS remain low, despite evidence suggesting decreased symptom burden and reduced use of health care in patients with heart failure and in critical care settings. PC should occur in tandem with mobilization of aggressive life-sustaining measures such as mechanical circulatory support (MCS) and extracorporeal membrane oxygenation (ECMO) in the care of patients presenting with CS. In this review, we describe the role of PC throughout the care continuum of patients with acute CS through to destination therapy with a left ventricular assist device. We explore the current use of PC in CS and challenges to goals-of-care discussions posed by MCS and ECMO, and highlight strategies on integrating PC in acute and chronic CS. Finally, we demonstrate the importance of incorporating PC early in management and challenge the traditional use of PC primarily as an end-of-life intervention.