Rationale

The impact of palliative care consultation on end-of-life care has not previously been evaluated in a multi-center study.

Objectives

To evaluate the impact of palliative care consultation on the incidence of cardiopulmonary resuscitation (CPR) performed and comfort care received at the end-of-life in hospitalized patients with COVID-19.

Methods

We used the Society of Critical Care Medicine’s COVID-19 registry to extract clinical data on patients hospitalized with COVID-19 between March 31st, 2020 to March 17th, 2021 and died during their hospitalization. The proportion of patients who received palliative care consultation was assessed in patients who did and did not receive CPR (primary outcome) and comfort care (secondary outcome). Propensity matching was used to account for potential confounding variables.

Measurements and Main Results: 3,227 patients were included in the analysis. There was no significant difference in the incidence of palliative care consultation between the CPR and no-CPR groups (19.9% vs. 19.4%, p = 0.8334). Patients who received comfort care at the end-of-life were significantly more likely to have received palliative care consultation (43.3% vs. 7.7%, p < 0.0001). After propensity matching for comfort care on demographic characteristics and comorbidities, this relationship was still significant (43.2% vs. 8.5%; p < 0.0001).

Conclusion

Palliative care consultation was not associated with CPR performed at the end-of-life but was associated with increased incidence of comfort care being utilized. These results suggest that utilizing palliative care consultation at the end-of-life may better align the needs and value of patients with the care they receive.

中文翻译：

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住院 COVID-19 患者的姑息治疗咨询和临终结果

基本原理

之前尚未在多中心研究中评估姑息治疗咨询对临终关怀的影响。

目标

评估姑息治疗咨询对 COVID-19 住院患者临终时实施心肺复苏 (CPR) 和接受舒适护理的影响。

方法

我们使用重症监护医学协会的 COVID-19 登记系统提取了 2020 年 3 月 31 日至 2021 年 3 月 17 日期间因 COVID-19 住院并在住院期间死亡的患者的临床数据。在接受和未接受心肺复苏术（主要结果）和舒适护理（次要结果）的患者中评估接受姑息治疗咨询的患者比例。倾向匹配被用来解释潜在的混杂变量。

测量和主要结果：3,227 名患者被纳入分析。CPR 组和非 CPR 组之间姑息治疗咨询的发生率没有显着差异（19.9% 对 19.4%，p = 0.8334）。在临终时接受舒适护理的患者更有可能接受姑息治疗咨询（43.3% 对 7.7%，p < 0.0001）。在对人口特征和合并症进行舒适护理的倾向匹配后，这种关系仍然显着（43.2% 对 8.5%；p < 0.0001）。

结论

姑息治疗咨询与临终时进行的心肺复苏术无关，但与使用舒适护理的发生率增加有关。这些结果表明，在临终时利用姑息治疗咨询可以更好地使患者的需求和价值与他们接受的护理保持一致。