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Futility in the paediatric cardiac ICU

Published online by Cambridge University Press:  24 July 2020

Michael P. Fundora Open the ORCID record for Michael P. Fundora [Opens in a new window] ,
Zahidee Rodriguez  and
William T. Mahle
Michael P. Fundora*
Affiliation:
Children’s Healthcare of Atlanta, Department of Pediatrics, Division of Cardiology, Emory University, Atlanta, GA, USA
Zahidee Rodriguez
Affiliation:
Children’s Healthcare of Atlanta, Department of Pediatrics, Division of Cardiology, Emory University, Atlanta, GA, USA
William T. Mahle
Affiliation:
Children’s Healthcare of Atlanta, Department of Pediatrics, Division of Cardiology, Emory University, Atlanta, GA, USA
*
Author for correspondence: M. P. Fundora, MD, Assistant Professor of Pediatrics, Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University School of Medicine, 1405 Clifton Road NE, Atlanta, GA30322-1062, USA. Tel: +404-785-1886; Fax: +404-785-6021. E-mail: [email protected]
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Abstract

Introduction:

Studies have suggested 5–20% of paediatric ICU patients may receive care felt to be futile. No data exists on the prevalence and impact of futile care in the Paediatric Cardiac ICU. The aim is to determine the prevalence and economic impact of futile care.

Materials and method:

Retrospective cohort of patients with congenital cardiac disease 0–21 years old, with length of stay >30 days and died (2015–2018). Documentation of futility by the medical team was retrospectively and independently reviewed.

Results:

Of the 127 deaths during the study period, 51 (40%) had hospitalisation >30 days, 13 (25%) had received futile care and 26 (51%) withdrew life-sustaining treatment. Futile care comprised 0.69% of total patient days with no difference in charges from patients not receiving futile care. There was no difference in insurance, single motherhood, education, income, poverty, or unemployment in families continuing futile care or electing withdrawal of life-sustaining treatment. Black families were less likely than White families to elect for withdrawal (p = 0.01), and Hispanic families were more likely to continue futile care than non-Hispanics (p = 0.044).

Conclusions:

This is the first study to examine the impact of futile care and characteristics in the paediatric cardiac ICU. Black families were less likely to elect for withdrawal, while Hispanic families more likely to continue futile care. Futile care comprised 0.69% of bed days and little burden on resources. Cultural factors should be investigated to better support families through end-of-life decisions.

Keywords

CHDfutilityend of lifecostcardiac critical carepalliative care
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 10 , October 2020 , pp. 1389 - 1396
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Basu, RK. End-of-life care in pediatrics: ethics, controversies, and optimizing the quality of death. Pediatr Clin 2013; 60: 725–739.Google ScholarPubMed
Kon, AA, Shepard, EK, Sederstrom, N et al. Defining futile and potentially inappropriate interventions: a policy statement from the Society of Critical Care Medicine Ethics Committee. Crit Care Med 2016; 44: 1769–1774.CrossRefGoogle Scholar
Bosslet, GT, Pope, TM, Rubenfeld, GD et al. An official ATS/AACN/ACCP/ESICM/SCCM policy statement: responding to requests for potentially inappropriate treatments in intensive care units. Am J Respir Crit Care Med 2015; 191: 1318–1330.CrossRefGoogle ScholarPubMed
Weise, KL, Okun, AL, Carter, BS et al. Guidance on forgoing life-sustaining medical treatment. Pediatrics 2017; 140: e20171905.CrossRefGoogle ScholarPubMed
Vemuri, G, Playfor, SD. Futility and inappropriate care in pediatric intensive care: a cross-sectional survey. Pediatr Anesth 2006; 16: 309–313.CrossRefGoogle ScholarPubMed
Goh, AY, Mok, Q. Identifying futility in a paediatric critical care setting: a prospective observational study. Arch Dis Child 2001; 84: 265–268.CrossRefGoogle Scholar
Huynh, TN, Kleerup, EC, Wiley, JF et al. The frequency and cost of treatment perceived to be futile in critical care. JAMA Intern Med 2013; 173: 1887–1894.CrossRefGoogle ScholarPubMed
Aviv, R. What Does It Mean to Die? The New Yorker. 2018.Google Scholar
Cohen, E. Fight over baby’s life support divides ethicists. CNNcom. 2007.Google Scholar
Truog, R. The “Right-To-Try” Experimental Treatments. Health Affairs. 2018.Google Scholar
Lee, KJ, Tieves, K, Scanlon, MC. Alterations in end-of-life support in the pediatric intensive care unit. Pediatrics 2010; 126: e859–e864.CrossRefGoogle ScholarPubMed
Huynh, TN, Kleerup, EC, Raj, PP, Wenger, NS. The opportunity cost of futile treatment in the intensive care unit. Crit Care Med 2014; 42: 1977–1982.CrossRefGoogle Scholar
Mu, P-F, Tseng, Y-M, Wang, C-C et al. Nurses’ experiences in end-of-life care in the PICU: a qualitative systematic review. Nursing science quarterly 2019; 32: 12–22.CrossRefGoogle ScholarPubMed
Sachdeva, RC, Jefferson, LS, Coss-Bu, J, Brody, BA. Resource consumption and the extent of futile care among patients in a pediatric intensive care unit setting. J Pediatr 1996; 128: 742–747.CrossRefGoogle Scholar
Carter, HE, Winch, S, Barnett, AG et al. Incidence, duration and cost of futile treatment in end-of-life hospital admissions to three Australian public-sector tertiary hospitals: a retrospective multicentre cohort study. BMJ Open 2017; 7: e017661.CrossRefGoogle ScholarPubMed
Bureau, USC. American FactFinder - Community Facts. 2011.Google Scholar
Gupta, P, Rettiganti, M, Gossett, JM et al. Epidemiologic trends of adoption of do-not-resuscitate status after pediatric in-hospital cardiac arrest. Pediatr Crit Care Medi 2019; 20: e432–e440.CrossRefGoogle ScholarPubMed