Pediatric Palliative Care Utilization Following Out-of-Hospital Cardiac Arrest at a Large US Quaternary Hospital

Background/Objective: Pediatric out-of-hospital cardiac arrest (OHCA) carries high morbidity and mortality, placing immense psychosocial and sudden decision-making burdens on families. Subspecialty pediatric palliative care (SPPC) can provide crucial support for these multifaceted needs, but its utilization and timing in this population remain poorly characterized. This study aimed to characterize the current rate, timing, and care domains addressed by SPPC utilization in pediatric patients admitted to the pediatric intensive care unit (PICU) following OHCA. Methods: This was a 13-year retrospective cohort study (2012-2024) conducted at Boston Children's Hospital, a quaternary academic children's hospital. This study included 126 patients up to 21 years of age who experienced an OHCA and were admitted to a PICU for at least 24 h. Primary outcomes included the rate of SPPC consultation, timing of the initial consultation, and documented domains of care addressed. Exploratory correlates included patient demographics and clinical factors associated with consultation. Results: Among 126 patients included, 23 (18.3%) received an SPPC consultation. SPPC utilization was significantly higher for Black or African American patients (47% of the SPPC group vs. 9.9% of the non-consult group) and patients with a greater number of pre-existing complex chronic conditions (median: 1 vs. 0). The SPPC cohort had a longer observed median PICU length of stay (22 days vs. 5 days) and hospital length of stay (36 days vs. 6 days) in unadjusted comparisons. The median time from admission to the first SPPC consult was 8 days. When consulted, SPPC addressed goals of care in 96% of cases, medical decision making in 83%, and psychosocial support in 74%. Conclusions: SPPC is not often utilized and is typically introduced later in the illness course during the care of children following OHCA, often associated with patients with prolonged or complex clinical courses. The significant demographic-associated variances in consultation rates highlight the risks of subjective referral practices, underscoring the need for standardized, proactive integration of palliative care to support all families navigating this devastating event.