Early guided palliative communication intervention to optimize family support and manage expectations for patients receiving extracorporeal membrane oxygenation (Ecmo)

ABSTRACT

Introduction: Extracorporeal membrane oxygenation (ECMO) is increasingly instituted for patients with severe circulatory or respiratory failure and as bridge to recovery or destination therapies (device implantation or organ transplantation). Morbidity and mortality for those patients is high. Hypothesis: ECMO combined with COVID isolation presents an additional set of challenges for patients, families. Objective: To test feasibility of an early, concurrent, and semi-structured palliative care intervention in improving communication, clarifying goals of care, and highlighting the experience of patients' families. Methods: IRB Approved Qualitative study using content analysis of guided, in-depth discussions with families of COVID-19 patients within 48-72 hours of being cannulated for ECMO between March-October 2020. Scripted template was developed to guide and facilitate goals of care conversations and to ensure consistent communication with family members throughout patients' disease trajectory. Patient demographics, comorbidities, clinical course, length of stay, and discharge disposition was obtained from the institution's COVID-19 Data Warehouse and analyzed using descriptive statistics Setting: Large urban academic medical center. Results: Patients were 44 ± 10 years, Hispanic or Latino 27/43 (63%), white 3 (7%), Black 8 (19%). Palliative care documentation for ECMO acknowledgement meeting was 36/43 (84%). Timely and guided communication demonstrated themes expressed by families including 1) social isolation and related grief of not being at patient's bedside;2) helping children of patients adjust to a new normal;3) coping with multiple family members suffering from COVID-19;4) importance of faith and spirituality;5) need for hope and gratitude 6) futility of prolonged ECMO stay. Survival to discharge 24/43 (56%). There was no statistical difference in hospital survival or length of stay between patients with and without documented palliative care. Conclusions: Early and ongoing palliative care intervention is feasible to support families' acknowledgment of complexity, benefits and limitations of ECMO, and it is useful in highlighting families' experiences, managing expectations and alleviating suffering.