• Ardith Z Doorenbos, Helene Starks, Erica Bourget, D Michael McMullan, Mithya Lewis-Newby, Tessa C Rue, Taryn Lindhorst, Eugene Aisenberg, Natalie Oman, J Randall Curtis, Ross Hays, Seattle Ethics in ECLS (SEE) Consortium, Jonna D Clark, Harris P Baden, Thomas V Brogan, Jane L Di Gennaro, Robert Mazor, Joan S Roberts, Jessica Turnbull, and Benjamin S Wilfond.
• Department of Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, WA 98195, USA. doorenbo@uw.edu
• J Palliat Med. 2013 May 1;16(5):492-5.

BackgroundExtracorporeal life support (ECLS) is an advanced form of life-sustaining therapy that creates stressful dilemmas for families. In May 2009, Seattle Children's Hospital (SCH) implemented a policy to involve the Pediatric Advanced Care Team (PACT) in all ECLS cases through automatic referral.ObjectiveOur aim was to describe PACT involvement in the context of automatic consultations for ECLS patients and their family members.MethodsWe retrospectively examined chart notes for 59 consecutive cases and used content analysis to identify themes and patterns.ResultsThe degree of PACT involvement was related to three domains: prognostic uncertainty, medical complexity, and need for coordination of care with other services. Low PACT involvement was associated with cases with little prognostic uncertainty, little medical complexity, and minimal need for coordination of care. Medium PACT involvement was associated with two categories of cases: 1) those with a degree of medical complexity but little prognostic uncertainty; and 2) those that had a degree of prognostic uncertainty but little medical complexity. High PACT involvement had the greatest medical complexity and prognostic uncertainty, and also had those cases with a high need for coordination of care.ConclusionsWe describe a framework for understanding the potential involvement of palliative care among patients receiving ECLS that explains how PACT organizes its efforts toward patients and families with the highest degree of need. Future studies should examine whether this approach is associated with improved patient and family outcomes.

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