THE IMPACT OF PALLIATIVE CARE FOR PATIENTS REQUIRING EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) SUPPORT: A MIXED-METHODS STUDY

Background: Palliative care (PC) is a patient and family centered model of care that prioritizes quality of life for patients with life-limiting illness. There is extensive evidence demonstrating the benefits of PC in patients in intensive care but no studies to date that examined the impact of PC for patients on extracorporeal membrane oxygenation (ECMO). We aimed to describe of PC utilization in patients requiring ECMO support and to compare key outcomes and experiences between those who received PC and those who did not. Methods: For this explanatory mixed-methods study, we employed quantitative analysis of data from a prospective, observational cohort of patients who received ECMO support between July 2016 and September 2021 and qualitative data collection via semi-structured interviews. We utilized ANOVA, Fisher’s Exact tests, and multivariate linear and logistic regression. We performed thematic analysis of interviews with patients and care partners. The analysis was guided by the biopsychosocial framework of health. Results: Of the 256 patients, the median age was 55 years (range 18 to 83) and 44.1% were seen by the PC team. After controlling for age and the specialty of the attending physician, there was no significant difference mortality comparing those who were seen by the PC team and those who were not. Additionally, patients who received a PC consult were significantly less sedated than those who did not. For the qualitative portion, 10 patients and 11 care partners were interviewed. More than half (n = 13, 62%) received a PC consult while on ECMO. They recounted symptoms such like pain, withdrawal, and delirium, psychological experiences like fear, anxiety, helplessness, and uncertainty about the future, and suggestions to improve communication, education, social support. Participants reported mixed feelings about PC. Conclusion: PC can benefit patients and care partners without increasing the likelihood of mortality but was underutilized in this population. More research is needed to define and quantify PC’s benefit and to develop new strategies to increase uptake of PC for patients on ECMO