Disclosures: Tony D. Nguyen, MD:

Case Diagnosis: Acute, traumatic C3 AIS B spinal cord injury (SCI)

Case Description: A 71-year-old previously independent male presented with acute tetraplegia after a ground-level fall resulting in C3 AIS B SCI requiring mechanical ventilation and vasopressor support. He underwent C3-C5 surgical decompression and fixation with minimal neurological recovery.

Setting: PACU, COVID-19 pandemicAssessment/

Results: Due to the ongoing COVID-19 surge resulting in limited ICU bed capacity, the patient was retained in the PACU for ongoing neurointensive care. The patient’s condition deteriorated, and palliative care was consulted to assist with goals-of-care discussion via virtual conference call. By hospital day 10, while still in the PACU due to hospital impaction, the patient demonstrated worsening delirium and had impaired decision-making capacity. The patient had an advanced directive that specified “no life support if irreversibly dying or in a vegetative state.” On follow-up discussion with the family, again by telemedicine, they elected for terminal extubation on hospital day 11. The patient and his family had their only live encounter since hospitalization at terminal extubation.

Discussion: Even in non-pandemic situations, a new SCI is a life-altering event for which counseling is a lengthy and iterative process. In the strained environment of the COVID-19 pandemic, these complex discussions were frequently abbreviated. In the current case, these obstacles were further exacerbated by limited ICU bed capacity resulting in a prolonged stay in the Post Anesthesia Care Unit (PACU). The shared PACU setting resulted in limited opportunities for quiet reflection, strained discussions via virtual conferencing, and social isolation, likely precipitating the patient’s delirium. Although predicting recovery following an acute SCI is difficult, it is possible that this patient and his family may have chosen an alternate care pathway in a non-pandemic setting.

Conclusion: The pandemic has significantly impacted medical care and end-of-life decision-making in critically ill patients, even patients who were not diagnosed with COVID-19.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/ramifications-of-the-covid-19-pandemic-on-end-of-life-decision-making-following-acute-traumatic-spinal-cord-injury-a-case-report/