title: Utilization of palliative care services for cardiac arrest patients undergoing therapeutic hypothermia: A retrospective analysis.
abstract: Palliative care (PC) services are integral to the care of patients with advanced medical illnesses. Given the significant morbidity and mortality associated with cardiac arrest, we sought to measure the use and impact of PC in the care of patients treated with therapeutic hypothermia (TH).
  
  
  
  We conducted a retrospective study of 317 consecutive patients undergoing TH after cardiac arrest. We compared intensive care unit (ICU) characteristics and clinical outcomes of subjects who received PC consultation (n=125) to those who did not (n=192).
  
  
  
  The proportion of TH patients with PC consultations increased to greater than 60% by 2013, corresponding to our institution's expansion of PC services, development of a dedicated PC unit, and integration of this service into our published TH protocol. In the TH population, time to return of spontaneous circulation (ROSC) was associated with higher inpatient mortality (p<0.001) and placement of a PC consult (p=0.011). TH patients who received PC consultation had longer ICU stays (p=0.034), more ventilator days (p<0.001), and higher inpatient mortality (p<0.001). When these measures were analyzed cohort-wide comparing all TH patients pre- and post-2013, at which time the frequency of PC consultation had dramatically increased, there were no statistically significant differences in ICU care or outcomes.
  
  
  
  In our population of cardiac arrest patients undergoing TH, the utilization of PC services has increased over time, particularly for those patients with high morbidity and mortality. Future randomized studies may further delineate optimal patient selection for PC consultation to better facilitate goals of care discussions and timely medical decision-making.
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, United States. Electronic address: ezern@partners.org.
authors.forename: Emily K
authors.initials: EK
authors.lastname: Zern
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, United States.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Young
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, United States.
authors.forename: Taylor
authors.initials: T
authors.lastname: Triana
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, United States.
authors.forename: Meng
authors.initials: M
authors.lastname: Xu
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, United States.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Holmes
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, United States.
authors.forename: Nyal
authors.initials: N
authors.lastname: Borges
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, United States.
authors.forename: John A
authors.initials: JA
authors.lastname: McPherson
authors.affiliation: Division of General Medicine and Public Health, Section of Palliative Care, Vanderbilt University Medical Center, United States.
authors.forename: Mohana B
authors.initials: MB
authors.lastname: Karlekar
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D000066491:Clinical Decision-Making; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods* / Q000401:mortality; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
keywords: Cardiac arrest; Hypothermia; Palliative care; Resuscitation