Factors associated with family decision-making after pediatric out-of-hospital cardiac arrest

Factors associated with family decision-making after pediatric out-of-hospital cardiac arrest

Frelinger JM; Tan JM; Klein MJ; Newth CJL; Ross PA; Winter MC

Resuscitation

2024

Hospitals Pediatric; child; article; controlled study; female; human; major clinical study; male; palliative therapy; medical decision making; hospitalization; advance care planning; pediatric intensive care unit; consultation; tracheostomy; clinical feature; adolescent; living will; decision making; intensive care unit; tertiary health care; feeding tube; do not resuscitate order; family decision making; out of hospital cardiac arrest; social determinants of health; do not intubate order

Aim: This study aims to identify demographic factors, area-based social determinants of health (SDOH), and clinical features associated with medical decision-making after pediatric out-of-hospital cardiac arrest (OHCA). Methods: This is a retrospective, exploratory, descriptive analysis of patients < 18 years old admitted to the pediatric intensive care unit (ICU) after OHCA from 2011 to 2022 (n = 217) at an urban tertiary care, free-standing children's hospital. Outcomes of interest included: (1) whether a new advance care plan (ACP) (defined as a written advance directive including do not resuscitate and/or do not intubate) was ordered during hospitalization, and (2) whether the patient was discharged with new medical technology (defined as tracheostomy and/or feeding tube). Logistic regression models identified features associated with these outcomes. Results: Of the 217 patients, 78 patients (36%) had a new ACP placed during their admission. Of the survivors, 26% (27/102) were discharged home with new medical technology. Factors associated with ACP were greater change in Pediatric Cerebral Performance Category (PCPC) score (aOR = 1.49, 95% CI [1.28-1.73], p-value < 0.001) and palliative care consultation (aOR = 2.39, 95% CI [1.16-4.89], p-value 0.018). Factors associated with new medical technology were lower change in PCPC score (aOR = 0.76, 95% C.I. [0.61-0.95], p-value = 0.015) and palliative care consultation (aOR = 7.07, 95% CI [3.01-16.60], p-value < 0.001). There were no associations between area-based SDOH and outcomes. Conclusions: Understanding factors associated with decision-making related to ACP after OHCA is critical to optimize counseling for families. Multi-institutional studies are warranted to identify whether these findings are generalizable.

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