1. Circumstances surrounding end‐of‐life in pediatric patients pre‐ and post‐heart transplant: a report from the Pediatric Heart Transplant Society
- Author
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John J. Parent, Seth A. Hollander, Sunkyung Yu, Melissa K. Cousino, Heather T. Henderson, Kurt R. Schumacher, Sairah Khan, and Elizabeth D. Blume
- Subjects
Male ,medicine.medical_specialty ,Palliative care ,Adolescent ,Heart Diseases ,Waiting Lists ,medicine.medical_treatment ,Population ,Psychological intervention ,Intensive Care Units, Pediatric ,Quality of life ,Risk Factors ,medicine ,Humans ,Hospital Mortality ,Registries ,Child ,education ,Pre and post ,Societies, Medical ,Mechanical ventilation ,Transplantation ,Univariate analysis ,education.field_of_study ,business.industry ,Mortality rate ,Infant, Newborn ,Infant ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,Quality of Life ,Heart Transplantation ,Female ,business - Abstract
Background Although mortality has decreased considerably in pediatric heart transplantation, waitlist and post-transplant death rates remain notable. End-of-life focused research in this population, however, is very limited. This Pediatric Heart Transplant Society study aimed to describe the circumstances surrounding death of pediatric heart transplant patients. Methods A retrospective analysis of the multi-institutional, international, Pediatric Heart Transplant Society registry was conducted. Descriptive statistics and univariate analyses were performed to 1) describe end-of-life in pediatric pre- and post-heart transplant patients and 2) examine associations between location of death and technological interventions at end-of-life with demographic and disease factors. Results Of 9217 patients (0-18 years) enrolled in the registry between 1993 and 2018, 2804 (30%) deaths occurred; 1310 while awaiting heart transplant and 1494 post-heart transplant. The majority of waitlist deaths (89%) occurred in the hospital, primarily in ICU (74%) with most receiving mechanical ventilation (77%). Fewer post-transplant deaths occurred in the hospital (22%). Out-of-hospital death was associated with older patient age (p Conclusions ICU deaths with high use of technological interventions at end-of-life were common, particularly in patients awaiting heart transplant. In this high mortality population, findings raise challenging considerations for clinicians, families, and policy makers on how to balance quality of life amidst high risk for hospital-based death.
- Published
- 2021