1 Adult Palliative Care, Department of Medicine, Columbia University Medical Center, New York, New York.
2 Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York.
J Palliat Med. 2019 Apr;22(4):432-436. doi: 10.1089/jpm.2018.0393. Epub 2019 Jan 7.
Little is known about palliative care consultation (PCC) for patients with cardiogenic shock requiring short-term mechanical circulatory support (STMCS).
To describe the utilization of PCC in this population.
Retrospective cohort study in a university medical center intensive care unit (ICU).
SETTING/PARTICIPANTS: In total, 195 patients aged >18 years with cardiogenic shock requiring STMCS were included. The cohort was divided into three categories: no PCC, early PCC (within seven days of STMCS), and late PCC (eight or more days after STMCS). Follow-up occurred during the index hospitalization.
Mean age was 59.3 ± 13.9 years; 67.9% were men. Mean follow-up period was 33.8 ± 37.7 days. Overall inpatient mortality was 52.3%. Ninety-four patients (48.2%) received PCC; 49 (25.1%) and 45 (23.1%) received early and late PCCs, respectively. STMCS duration, ICU stay after STMCS, and hospital stay after STMCS were significantly shorter in the no PCC group than the early PCC group (4 vs. 12 days, p < 0.001; 11 vs. 19 days, p = 0.004; and 16 vs. 19 days, p = 0.031; respectively). ICU stay after STMCS and hospital stay after STMCS were significantly shorter in the early PCC group than the late PCC group (19 vs. 38 days, p < 0.001; 19 vs. 49 days, p < 0.001; respectively). However, time from initial PCC to discharge was not significantly different between early and late PCC groups (18 vs. 31 days, p = 0.13).
PCC was utilized in almost half of patients with cardiogenic shock requiring STMCS. PCC tends to occur toward the end of life regardless of the duration of STMCS. The optimal PCC timing remained unclear.
对于需要短期机械循环支持（STMCS）的心源性休克患者，人们对姑息治疗咨询（PCC）知之甚少。
描述该人群中 PCC 的使用情况。
在一所大学医学中心的重症监护病房（ICU）进行的回顾性队列研究。
设置/参与者：共纳入 195 名年龄>18 岁、需要 STMCS 的心源性休克患者。该队列分为三组：无 PCC、早期 PCC（STMCS 后 7 天内）和晚期 PCC（STMCS 后 8 天或以上）。随访发生在住院期间。
平均年龄为 59.3±13.9 岁，67.9%为男性。平均随访时间为 33.8±37.7 天。总体住院死亡率为 52.3%。94 名患者（48.2%）接受了 PCC；49 名（25.1%）和 45 名（23.1%）分别接受了早期和晚期 PCC。无 PCC 组 STMCS 持续时间、STMCS 后 ICU 入住时间和 STMCS 后住院时间均显著短于早期 PCC 组（4 天比 12 天，p<0.001；11 天比 19 天，p=0.004；16 天比 19 天，p=0.031）。STMCS 后 ICU 入住时间和 STMCS 后住院时间在早期 PCC 组均显著短于晚期 PCC 组（19 天比 38 天，p<0.001；19 天比 49 天，p<0.001）。然而，早期 PCC 和晚期 PCC 组之间从初始 PCC 到出院的时间没有显著差异（18 天比 31 天，p=0.13）。
在需要 STMCS 的心源性休克患者中，近一半接受了 PCC。PCC 往往发生在生命的末期，而与 STMCS 的持续时间无关。最佳 PCC 时机仍不清楚。
