Outcomes of Palliative Care in Extracorporeal Life Support: A Systematic Review

Context: Use of palliative care in extracorporeal life support (ECLS) has increased, but its impact on patient- and family-centered outcomes remains unclear. Objective: To examine the relationship between specialty palliative care and patient- and family-centered outcomes for patients receiving ECLS. Methods: We conducted a systematic review of PubMed, EMBASE (Elsevier), CINAHL Complete (EBSCOhost), Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials (Wiley) through August 26, 2024. Two investigators independently screened titles and abstracts, followed by full-text review for inclusion. Data were extracted for prespecified critical and important outcomes, and evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: Nine observational studies were included, incorporating data from 21,417 patients receiving ECLS, with 4368 seen by specialty palliative care. For all outcomes, certainty of evidence was very low. Two studies included a critical outcome: one found no difference in “average pain” and one reported more goals-of-care notes, comparing those seen by palliative care to those not seen. Five studies reported longer ECLS duration among those with palliative care consultation compared to those without. Three studies performed statistical comparisons of survival for patients with and without palliative care consultation and found no significant differences in hospital mortality. Conclusion: Few studies have investigated patient- and family-centered outcomes related to specialty palliative care for patients receiving ECLS. Specialty palliative care does not appear to correlate with mortality, supporting the concept that palliative care can support goals-of-care conversations and end-of-life decision making without negatively affecting patient survival. However, limitations of the existing data preclude meaningful conclusions about the relationship between specialty palliative care and other patient- and family-centered outcomes. Additional research is needed to clarify the optimal role of specialty palliative care in this population.