.jpg "Ali Tabatabai, MD, photo")
Ali Tabatabai, MD,
Associate Professor
University of Maryland
Baltimore, MD
Disclosure information not submitted.
Rachel Nathan, M.D.
Assistant Professor
University of Maryland School of Medicine, United States
Disclosure information not submitted.
Megan Anders, MD, MS
Assistant Professor of Anesthesiology
University of Maryland Medical Center, United States
Disclosure information not submitted.
Miranda Gibbons
Business Intelligence Developer
University of Maryland School of Medicine, United States
Disclosure information not submitted.
Marguerite Russo, CRNP
Nurse Practitioner
University of Maryland School of Nursing, United States
Disclosure information not submitted.
Sarah Whitehead, CRNP
Nurse Practitioner
University of Maryland Medical Center, United States
Disclosure information not submitted.
Raya Kheirbek, M.D.
Professor of Medicine
University of Maryland Medical Center, United States
Disclosure information not submitted.
Title: The Role of Early Palliative Support in Highlighting Family Experiences of COVID-19 Patients on ECMO
Introduction: Extracorporeal membrane oxygenation (ECMO) is instituted for patients with COVID-19 in severe circulatory or respiratory failure as bridge to recovery or destination therapies (device implantation or organ transplantation). Morbidity and mortality for patients on ECMO is high, presenting an additional set of challenges for patients, families, and caregivers.
Objective: The main objective was to describe the role of the palliative care team for patients on ECMO for COVID-19 complications
Methods: Qualitative study using content analysis of early, concurrent and guided in-depth discussions with families of COVID-19 patients over the age of 18 within 72 hours of being cannulated for ECMO. Meetings with patients’ families were held between March-October 2020. Scripted template was developed to acknowledge the role and limitations of ECMO, to guide and facilitate goals of care conversations, and to ensure consistent communication with family members.
Setting: Large urban academic medical center in Maryland.
Ethical Considerations: We obtained approval from the Institutional Review Board at the University of Maryland, Baltimore.
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. These included 1) social isolation and related grief of being unable to be 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) the need for hope and gratitude; and, 6) futility of prolonged ECMO stay. Survival to discharge 24/43 (56%). There was no statistical difference in survival to discharge or length of stay between patients with and without documented palliative care consultation.
Conclusions: The ongoing pandemic presents a unique set of challenges for families of patients suffering with COVID-19. Early and ongoing palliative care intervention is useful in highlighting patients and families experience. increasing awareness supporting their disease complexity and limitations of ECMO, managing expectations during a time of uncertainty, and alleviating suffering.