Background: Given that patients admitted to today's cardiac intensive care units (CICU) are more critically ill than ever, palliative care is becoming an increasingly important aspect in their comprehensive care. The goal of this study is to quantify the degree to which palliative care plays a role in the care of critically ill cardiac patients, as well as to highlight the ways in which end of life decision-making is carried out in today's CICU. Methods: All admissions to the Mount Sinai cardiac care unit (CCU) from January 1 through December 31, 2012 were reviewed retrospectively via the electronic medical record (1,368 in total). The 117 CCU patients who died during the hospital stay were studied in more detail. We compared length of stay, redirected Goals of Care (GOC), palliative extubation, and withdrawal of other therapies in patients with extensive GOC discussion versus those with no GOC discussion. The study was approved by the Mount Sinai Internal Review Board. Results: Of the 117 CCU patients who died during the same hospital admission, a total of 85 patients and/or surrogates had some form of goals of care discussions. The CCU team had these discussions with 48 patients/surrogates, while 37 patients/surrogates received a formal palliative care consultation. Another 32 patients died without any end of life care discussions. Subjects undergoing GOC discussions have a higher rate of redirected GOC toward comfort care or no escalation of care (33 patients, 38.82% vs. 1 patient, 3.13%; p< 0.001) and palliative extubation (18 patients, 21.18% vs. 1 patient, 3.13%; p= 0.01) than patients with no GOC discussions. With the exception of LVAD discontinuation for which 5 of the 6 patients had the device turned off in the CCU, these end of life interventions were split evenly between the PCU and the CCU. Conclusion: Our study quantifies the extent of palliative care and end-of-life decision making in a busy tertiary care CICU. Given the increasing severity of illness in our critically ill cardiac patients, the modern cardiac intensivist will inevitably face complex end of life issues. Consequently, we advocate for increased palliative care education and training among clinicians who are involved in cardiac critical care.
Naib, T., Lahewala, S., arora, S., & Gidwani, U. (2014). PALLIATIVE CARE IN THE CARDIAC INTENSIVE CARE UNIT. Journal of the American College of Cardiology, 63(12), A913. https://doi.org/10.1016/s0735-1097(14)60913-x