[Change in goal-of-care in a cardiological intensive care unit-retrospective medical record analysis]

Intensive care units (ICU) are primarily focused on maximum therapy and life extension. Changes of goals-of-care in favor of quality of life and a dignified dying process remain a particular challenge.

To analyze the implementation of changes of goal-of-care in a cardiology ICU.

Retrospectively assessed were medical records from 40 randomly selected patients who died between July 2019 and August 2021 in the cardiology ICU at University Hospital Cologne. Descriptive statistics were performed using SPSS (IBM, Armonk, NY, USA) software.

The median age of the patients was 70.5 years; 75% were male and average length of stay was 4 days (median). Cause of death was mostly due to cardiac or pulmonary causes (30/40 medical records). Changes of goal-of-care were documented for 65% of patients; this group was generally older and had a longer stay. Changes of goal-of-care mostly occurred within the last 24 h of life (81%). Decisions were mostly made together with relatives, as patients were often no longer able to communicate (85%). Avoidance of escalation of measures was more common than de-escalation.

We identified two groups of patients with different challenges regarding changes of goal-of-care: (1) Patients with sudden death within 72 h, for whom changes of goal-of-care is rarely possible, making resilience in dealing with dying patients and communication with relatives crucial for the treating personnel. (2) Patients with longer stays, where changes of goal-of-care are more frequently implemented. For this group, continuous re-evaluation of goal-of-care and, in this context, medical indications and patient wishes are particularly important.