Project Summary Research: Extracorporeal membrane oxygenation (ECMO) is an advanced technology that is increasingly used to sustain life for some of the sickest patients in the intensive care unit (ICU). This form of life support has potential to serve as a crucial bridge to recovery or durable treatment for many patients with cardiac or pulmonary failure, but mortality exceeds 50%, and some patients remain dependent on ECMO for weeks to months without a clear path toward liberation from life support. Because some forms of ECMO can sustain life nearly indefinitely, death is frequently in the context of complex decisions to withdraw ECMO support. Family members of patients on ECMO play a key role as surrogate-decision maker in these challenging decisions and have been found to experience high levels of psychological distress associated with their loved one’s illness. The high illness severity of patients supported by ECMO, the unique ability of ECMO to sustain life for extended periods of time even when prognosis is extremely poor, and the increased psychological distress among family members of patients on ECMO suggest that there may be a role for increased palliative care support for these patients and their families. Palliative care is often offered by a specialty palliative care consulting service that can support patients and families in determining goals of care, help align treatments towards goal-concordant care, and address psychosocial distress, all of which are pertinent issues for patients supported with ECMO and their families. With widespread adoption of ECMO occurring only recently, there has been little research into the palliative care needs of this population. The objective of this project is to define current use of specialty palliative care for patients on ECMO and their families (Aim 1), and to use a qualitative approach to explore palliative care needs among this population (Aim 2). Accomplishing these two aims will expose unmet needs of patients on ECMO and their families, which will in turn be the target for future palliative care and supportive intervention trials. Identification of these needs and development of interventions designed to address them are key steps in improving the quality of ECMO-related care. Candidate and Environment: With the support of Dr. Erin Kross, Dr. Claire Creutzfeldt, Dr. Daniel Brodie, biostatistician Dr. Lyndia Brumback, and qualitative expert Dr. Danae Dotolo, Dr. Kiker is establishing herself as a promising and enthusiastic physician-scientist. The proposed research will be instrumental in her research training from both content and methodological perspectives. Results from these studies will determine future targets for palliative care-based interventions to support patients on ECMO and their families and improve the quality of ECMO-related care. Skills gained in statistical analysis and qualitative methodology will facilitate success as she applies for a career development award, and later for independent investigator awards.

Project Narrative Patients supported by extracorporeal membrane oxygenation (ECMO) and their families likely have numerous palliative care needs due to high mortality and complication rates for patients, increased psychological distress for families, and the unique ability of ECMO to support life nearly indefinitely even when prognosis is very poor. Despite the exponentially increasing use of ECMO for cardiac and pulmonary failure, research into the palliative care needs of these patients and their families is lacking. This project aims to better understand which patients on ECMO are receiving specialty palliative care support, what type of support palliative care services are providing, and what types of support patients and their family members need.