Advancing palliative care in cardiac arrest and cardiogenic shock: Identifying evidence gaps and future research priorities

INTRODUCTION: Cardiac arrest and cardiogenic shock are life-threatening cardiovascular emergencies that impose substantial physical, psychological, and decisional burdens on patients and caregivers. Palliative care, defined as holistic, person-centered care focused on preventing and relieving symptoms and stressors of serious illnesses to improve quality of life for patients and caregivers, is increasingly recognized as an essential component of comprehensive cardiovascular care.

OBJECTIVES: We therefore conducted a narrative review to synthesize current evidence regarding inpatient palliative care in cardiac arrest and cardiogenic shock; identify critical gaps in research and practice; and propose future directions to guide clinicians, researchers, and policymakers, while centering patients and caregivers.

DISCUSSION: In the U.S., palliative care utilization for patients with cardiac arrest and cardiogenic shock has increased significantly over the last two decades. However, the literature on palliative care in cardiac arrest and cardiogenic shock is limited, demonstrating that palliative care consultation is associated with increased do-not-resuscitate orders and withdrawal of life-sustaining treatments, as well as decreased healthcare utilization and subsequent costs. However, patient- and caregiver-centered outcomes have not been studied. Major palliative care research gaps exist in measurement, equity, education, and delivery models, including the optimal roles of generalist vs. specialist palliative care. Future research should prioritize patient- and caregiver-centered outcomes, comparative effectiveness of different palliative care delivery models, implementation science, health equity, and education and training of generalist palliative care skills to optimize palliative care integration for cardiac arrest and cardiogenic shock to improve the lived experience of these patients and their caregivers.

National Heart, Lung, and Blood Institute

Anne Song, Oscar JL Mitchell, Jacopo D’Andria Ursoleo, Donald R Sullivan, William E Rosa, Katherine R Courtright, Rachel Kohn