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Palliative Care Utilization Following Out-of-Hospital Cardiac Arrest in Pediatrics. | LitMetric

Palliative Care Utilization Following Out-of-Hospital Cardiac Arrest in Pediatrics.

Crit Care Explor

Department of Pediatric Critical Care Medicine, The University of Chicago, Chicago, IL.

Published: February 2022

AI Article Synopsis

  • The study investigates the use of pediatric palliative care (PPC) for children who experience out-of-hospital cardiac arrest (OHCA) and compares characteristics of those who received PPC to those who did not.
  • The research found that only 28.8% of eligible patients received PPC, and those who did had longer stays in the pediatric intensive care unit (PICU), more ventilator days, and more often had do-not-resuscitate (DNR) orders.
  • The study concludes that while PPC could be beneficial, it is underutilized, and further research is needed to understand how to better integrate PPC into the care of pediatric OHCA patients.

Article Abstract

Objectives: Pediatric out-of-hospital cardiac arrest (OHCA) is associated with significant morbidity and mortality. Pediatric palliative care (PPC) services could provide an integral component of the comprehensive care necessary for these patients and their families. The main objectives of this study are to examine the utilization of PPC following OHCA and compare the differences in characteristics between children who received PPC with those who did not.

Design: Retrospective cohort study.

Setting: An urban, tertiary PICU.

Patients: Children less than 21 years old admitted from October 2009 to October 2019 with an admitting diagnosis of OHCA and minimum PICU length of stay (LOS) of 48 hours.

Interventions: None.

Measurements And Main Results: Of the 283 patient charts reviewed, 118 patient encounters met inclusion criteria. Of those, 34 patients (28.8%) received a PPC consultation during hospitalization. Patients who received PPC had a longer PICU LOS (14.5 vs 4.0 d), a greater number of ventilator days (12.5 vs 4.0 d), and a larger proportion of do-not-resuscitate (DNR) statuses (41% vs 19%). When comparing the disposition of survivors, a greater proportion was discharged to rehab or nursing facilities (47% vs 28%), with no difference in mortality rates (53% vs 50%). In the multivariate logistic regression model, older age, longer LOS, and code status (DNR) were all associated with higher likelihood of PPC utilization. Data were analyzed using descriptive, Mann-Whitney , and Fisher exact statistics.

Conclusions: Our study demonstrates PPC services following OHCA are underutilized given the high degree of morbidity and mortality. The impact of automatic PPC consultation in all OHCA patients who survive beyond 48 hours should be explored further. Future studies are warranted to understand the benefits and barriers of PPC integration into standard postarrest care for patients and families.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8860333PMC
http://dx.doi.org/10.1097/CCE.0000000000000639DOI Listing

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