RPD114 - Not Just for the Dying: The Benefits of Early Palliative Medicine Consult in ECMO Care

Key Message : This retrospective cohort study shows that early palliative medicine consultation improves care planning and multidisciplinary support for ECMO patients without affecting survival. It reframes palliative medicine as a proactive, essential component of critical care and underscores the need for national guidelines to guide its integration in ECMO settings.

Abstract: Background/Rationale:
Palliative medicine (PM) aims to enhance the quality of life of patients and families facing serious illness. Among the most critically ill are patients requiring extracorporeal membrane oxygenation (ECMO), an advanced life support therapy for severe cardiac and/or respiratory failure. Although in-hospital mortality for these patients approaches 40.0% (1), no national guidelines currently address the role of PM in ECMO care (2).
Objectives/

Purpose:
This study investigates whether early, protocolized palliative medicine consultation improves care planning and multidisciplinary support services for patients requiring ECMO.
Methods/Approach:
We conducted a retrospective cohort analysis of adult ECMO patients hospitalized in 2023 at a tertiary academic medical center. During this time, a protocolized approach to PM was piloted—a default PM consult was embedded in the initial ECMO order set, and providers could opt out. Outcomes were compared between 91 patients who received a PM consult and 14 who did not, using Fisher’s exact and unpaired two-sample t-tests.

Results:
Patients with a PM consult were significantly more likely to have a medical power of attorney identified (p < 0.0001) and an advance care planning note written (p = 0.0091). PM consultation was also associated with increased social work, chaplaincy, and child life involvement in patient care. Survival rates were notably comparable between patients with and without a PM consult (58.2% vs. 57.2%).
Conclusion/Implications:
Given the similar survival rates and care-planning needs of both cohorts, we extrapolate that all ECMO patients stand to benefit from PM involvement—not just those perceived as facing imminent death. Our findings support a protocolized approach to early PM consultation in ECMO care and highlight the need for national guidelines.

References: 1. Fernando SM, Qureshi D, Tanuseputro P, et al. Mortality and costs following extracorporeal membrane oxygenation in critically ill adults: a population-based cohort study. Intensive Care Med. 2019 Nov;45(11):1580-1589. doi: 10.1007/s00134-019-05766-z. Epub 2019 Sep 16. PMID: 31529353.

2. Stevens K, Anandan SR, Rahman H, et al. Caring for Patients Requiring Venous Arterial Extracorporeal Membrane Oxygenation: Can Upstream Palliative Care Make a Difference? Am J Hosp Palliat Care. 2024 Dec;41(12):1431-1441. doi: 10.1177/10499091241226606. Epub 2024 Jan 9. PMID: 38195411.