Value of ECMO Support in Palliative Care for Postcardiotomy End-Stage Heart Failure Patients

Abstract

SESSION TITLE: Critical Care Nonpulmonary SESSION TYPE: Original Investigation Poster PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM PURPOSE: Once patients (pts) developed post-cardiotomy end- stage heart failure, the mortality rate was very high. Using extracorporeal membrance oxygenation (ECMO) support as palliative/spiritual care for those either in conscious or in comatose state is a valuable alternative. These pts do need a palliative or hospice care program to support them and their family member through the dying and the bereavement period. We reviewed our cases retrospectively and assured the value of palliative / spiritual care in these pts with nearly medical futility. METHODS: 29 pts developed postcardiotomy end-stage heart failure (NYHA Class IV) and were on ECMO support at CVS division of CSMUH from Jan. 2003 to Dec. 2013. 16 pts were weaned off ECMO but only 11 were successful. 8pts were survived to hospital discharge. 9 out 13 pts could not be weaned off ECMO were in comatose state (GCS; 7 E1M1Vt, 1E1M2Vt & 1E3M5Vt) and the rest 4 pts were in conscious state. They were put into hospice and palliative / spiritual care, respectively. Another 8 out of 16 pts those who could be weaned off ECMO required palliative / spiritual care at ICU or RCC and eventually deceased. RESULTS: 8 pts required spiritual care during their hospital stay (6 to 62 days, mean 31.1d) and survived to their hospital discharge without post-traumatic stress syndorme or depression. Palliative / spiritual care were applied to those could not be weaned off ECMO (9 unconscious and 4 conscious). Through an interdisciplinary approach, it did result in alleviation of sufferings of both pts and their family members through the process of possible dying and the dying and bereavement period. CONCLUSIONS: ECMO support is a valuable alternative to provide a short period of palliative / spiritual care for pts with postcardiotomy end- stage heart failure and their family member through an interdisciplinary team approach. CLINICAL IMPLICATIONS: ECMO support is a valuable alternative to provide a short period of palliative / spiritual care for pts with postcardiotomy end- stage heart failure and their family member through an interdisciplinary team approach. DISCLOSURE: The following authors have nothing to disclose: Tsung-Po Tsai, An-Hua Sun, Su-Chin Tsao, Jung-Ming Yu, Shih-Chen Tsai, Heng Su No Product/Research Disclosure Information