Palliative care in the cardiovascular intensive care unit: A systematic review of current literature

BACKGROUND

There has been an evolution in the disease severity and complexity of patients presenting to the cardiac intensive care unit (CICU). There are limited data evaluating the role of palliative care in contemporary CICU practice.

METHODS

PubMed Central, CINAHL, EMBASE, Medline, Cochrane Library, Scopus, and Web of Science databases were evaluated for studies on palliative care in adults (≥18 years) admitted with acute cardiovascular conditions - acute myocardial infarction, cardiogenic shock, cardiac arrest, advanced heart failure, post-cardiac surgery, spontaneous coronary artery dissection, Takotsubo cardiomyopathy, and pulmonary embolism - admitted to the CICU, coronary care unit or cardiovascular intensive care unit from 1/1/2000 to 8/8/2022. The primary outcome of interest was the utilization of palliative care services. Secondary outcomes of included studies were also addressed. Meta-analysis was not performed due to heterogeneity.

RESULTS

Of 5711 citations, 30 studies were included. All studies were published in the last seven years and 90 % originated in the United States. Twenty-seven studies (90 %) were retrospective analyses, with a majority from the National Inpatient Sample database. Heart failure was the most frequent diagnosis (47 %), and in-hospital mortality was reported in 67 % of studies. There was heterogeneity in the timing, frequency, and background of the care team that determined palliative care consultation. In two randomized trials, there appeared to be improvement in quality of life without an impact on mortality.

CONCLUSIONS

Despite the growing recognition of the role of palliative care, there are limited data on palliative care consultation in the CICU.

Intravenous streptokinase in an infant with Kawasaki's disease complicated by acute myocardial infarction

A seven-month-old boy with Kawasaki's disease developed an acute anterior myocardial infarction. Following intravenous thrombolytic therapy (streptokinase), complete resolution of echocardiographic wall motion abnormalities and significant reperfusion of the anterior wall on thallium-201 scintigraphy were noted. Discussion centers on the potential utility of intravenous thrombolysis in this condition.

Ventricular fibrillation in a tetraplegic patient who had a therapeutic level of a tricyclic antidepressant. Case report

A case is presented of a young, chronic tetraplegic patient who, shortly after achieving therapeutic levels of imipramine, a tricyclic antidepressant (TCA) developed a life-threatening ventricular arrhythmia. Since tetraplegic patients frequently manifest evidence of autonomic supersensitivity, the autonomic effects of the TCA may have led to the cardiac arrhythmia. Caution should be exercised in the use of TCA's in tetraplegic patients.