• En-Ting Wu, Ching-Chia Wang, Shu-Chien Huang, Chieh-Ho Chen, Shiann-Tarng Jou, Yih-Charng Chen, Mei-Hwan Wu, and Frank Leigh Lu.
• Department of Pediatrics, National Taiwan University Children's Hospital and College of Medicine, Taipei, Taiwan.
• Pediatr Crit Care Me. 2021 Aug 1; 22 (8): 733742733-742.

ObjectivesMedical advances and the National Health Insurance coverage in Taiwan mean that mortality in the PICU is low. This study describes change in modes of death and end-of-life care in a single center, 2011-2017.SettingMultidisciplinary PICU in a tertiary referral Children's Hospital in Taiwan.PatientsThere were 316 deaths in PICU patients.InterventionsPalliative care consultation in the PICU service occurred after the 2013 "Hospice Palliative Care Act" revision.Measurements And Main ResultsIn the whole cohort, 22 of 316 patients (7%) were determined as "death by neurologic criteria". There were 94 of 316 patients (30%) who had an event needing cardiopulmonary resuscitation within 24 hours of death: 17 of these patients (17/94; 18%) died after failed cardiopulmonary resuscitation without a do-not-resuscitate order, and the other 77 of 94 patients (82%) had a do-not-resuscitate order after cardiopulmonary resuscitation. Overall, there were 200 of 316 patients (63%) who had a do-not-resuscitate order and were entered into the palliative program: 169 of 200 (85%) died after life-sustaining treatment was limited, and the other 31 of 200 (15%) died after life-sustaining treatment was withdrawn. From 2011 to 2017, the time-trend in end-of-life care showed the following associations: 1) a decrease in PICU mortality utilization rate, from 22% to 7% (p < 0.001); 2) a decrease in use of catecholamine infusions after do-not-resuscitate consent, from 87% to 47% (p = 0.001), in patients having limitation in life-sustaining treatment; and 3) an increase in withdrawal of life-sustaining treatment, from 4% to 31% (p < 0.001).ConclusionsIn our practice in a single PICU-center in Taiwan, we have seen that the integration of a palliative care consultation service, developed after the revision of a national "Palliative Care Act," was associated with increased willingness to accept withdrawal of life-sustaining treatment and a lowered PICU care intensity at the end-of-life.Copyright © 2021 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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