Exploring Compassionate Extubations: Challenges, Needs, and Solutions From the Respiratory Therapy Perspective

Background: Compassionate extubation (CE) may be part of end-of-life (EOL) care provided in an acute care patient care environment. CE has been shown to create emotional and ethical dilemmas for healthcare professionals. This study seeks to explore the challenges and needs of RTs related to CE. Methods: Licensed RTs in Ohio were provided a survey link. Inclusion criteria included working in critical care and participating in CE. In addition to participant demographics, the survey asked about previous education, policies, procedures and protocols, communication, and debriefing and support regarding CE and EOL. IRB approval was obtained prior to survey distribution. Descriptive statistics were calculated. Results: 297 responses were included. 71% of respondents indicated performing CEs was emotionally challenging. The most challenging aspects of CE were inadequate education on the emotional burden of CE (59%) and inadequate support post CE (62%). 13% of respondents reported someone had reached out to them post CE to provide support. 50% of respondents reported being included in EOL discussions, and 77% felt being included in EOL discussions would improve feelings of preparedness for performing CE. Many respondents desired a standardized CE protocol that would include medication administration, guidance and support for family interactions, and post-CE debrief or check-in for RT and others. A theme identified from written responses included inadequate family preparation for the CE and EOL process. Many respondents indicated they were not trained to support families during CE, and family reaction to CE was a significant source of emotional burden. Conclusions: There are opportunities to improve aspects of CE to decrease the emotional burden experienced by RTs. Incorporating RTs in EOL and CE discussions with the patient and family, implementing time-outs with the healthcare team prior to performing CE, education and protocols that address providing support for the family, and implementing a debrief, check-in, and/or break from patient care for the RT post-CE procedure would meet the needs identified by RTs.