Association of Palliative Care Consultation with Outcomes after Out-of-Hospital Cardiac Arrest

BackgroundOut-of-hospital cardiac arrest (OHCA) is associated with high morbidity and mortality, often requiring complex decision-making in the intensive care unit (ICU). Palliative care may facilitate goal-aligned care but remains underutilized in this population.ObjectiveTo evaluate the impact of palliative care consultation on end-of-life decision-making and clinical outcomes in ICU patients following OHCA.MethodsWe conducted a mixed retrospective-prospective cohort study of 61 retrospective and 40 prospective adult patients admitted to the ICU after OHCA at a tertiary academic center. Patients were grouped by palliative care consultation. Primary outcomes were in-hospital mortality and ICU and hospital length of stay. Secondary outcomes included the proportion of patients with code status change, the timing of code status changes and withdrawal of life-sustaining treatment from ICU admission in both groups, and withdrawal of life-sustaining treatment. Illness severity was assessed using the Sequential Organ Failure Assessment (SOFA) score at ICU admission and at 72 hours.ResultsAmong 101 patients admitted after OHCA, 34 (33.7%) received a palliative care consultation. In-hospital mortality was higher among patients who received palliative care consultation than among those who did not (79.4% vs 41.8%; P = 0.0003). SOFA scores at ICU admission and at 72 hours were similar between patients seen by palliative care and those not seen by palliative care (P = 0.72 and P = 0.27, respectively). All patients who received a palliative care consultation (100%) had a change in code status during hospitalization, compared to 32.8% of those who did not (P < 0.0001). The time from ICU admission to withdrawal of life-sustaining treatment was significantly longer in the palliative care group (6.0 vs 3.0 days, P = 0.016), while the time to code status change was similar between groups (P = 0.415). There were no significant differences in ICU or hospital length of stay, or use of vasopressors, mechanical ventilation, or continuous renal replacement therapy. Among patients who received palliative care consultation, the most common interventions included goals-of-care clarification (85.3%), symptom management, and spiritual or emotional support.ConclusionIn ICU patients following OHCA, palliative care consultation was associated with higher in-hospital mortality despite similar baseline characteristics, illness severity by SOFA score, and treatment intensity, likely reflecting preferential consultation in patients with greater clinical complexity rather than a causal relationship. Palliative care consultation was strongly associated with goals-of-care redirection and a more deliberate process of end-of-life decision-making.