LAUSR

Learning Objectives: Once patients developed postcardiotomy end-stage heart failure, the in-hospital mortality rate was high (60~80%). We designed a palliative program at ICU to support patients and their family members facing the dying and the bereavement period spiritually. Methods: A retrospective observational study utilizing data of His hospital medical record system, from Jan 2003 to Dec 2017. There were 56 out of 1,345 cardiac surgical patients developed postcardiotomy end-stage heart failure requiring mechanical circulatory support (MCS) (ECMO or VAD). Among them, 4 patients (2 CABG, 1 VSD repair + TVR, 1 Apico-aortic conduit) required ECMO and one patient (CABG) later required VAD circulatory support for more than 5 days. Their preoperative GCS (Glasgow Coma Scale) scores were 15 (E4M6V5), however after the surgery, GCS scores changed to E3M5Vt, E2M4Vt, E4M6V5 and E4M6Vt, respectively. The MCS could not be weaned in each case. Therefore, a palliative care team (including palliative care clinician, nurse, family members and patient) was engaged in every case to do palliative interventions; team discussion and explanation of the treatments target, inform the patient and surrogates the possible complications of using MCS (ECMO or VAD), consult interdisciplinary experts and pursuit extramural appeal. Results: MCS duration were 8 to 50 days with a mean of 19 days (M:F=4:1). Mechanical Circulatory Support (ECMO or VAD) could not be weaned or removed in these 5 patients until they fell unconsciousness again and became hemodynamically unstable. One patient who gained consciousness but failed to wean off ECMO decided the inheritance and then loss consciousness later. We gained 95% of satisfaction from patients’ family and surrogates after Questionares. Conclusions: Mechanical circulatory Support is a valuable alternative to provide a short period of palliative/spiritual care for patients with postcardiotomy end-stage heart failure and their family members through an interdisciplinary team approach. CCMCritical Care MedicineCrit Care Med0090-3493Lippincott Williams & WilkinsHagerstown, MDCCM