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Begrenzung und Abbruch lebenserhaltender Maßnahmen bei kritisch kranken kardiochirurgischen Patienten

Ergebnisse einer bundesweiten Umfrageaktion

End-of-life decisions and practices in critically ill patients in the cardiac intensive care unit

A nationwide survey

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Zusammenfassung

Hintergrund

Ethische und medizinische Kriterien der Entscheidungsfindung bezüglich Therapiebegrenzung oder Therapieabbruch von lebenserhaltenden Maßnahmen bei kritisch kranken Patienten stellen eine große Herausforderung in der Intensivmedizin dar.

Fragestellung

Welche medizinischen und ethischen Kriterien sind bei kritisch kranken kardiochirurgischen Patienten bei der Entscheidungsfindung zur Therapiezieländerung mitentscheidend?

Material und Methoden

Es wurde eine Fragebogenevaluierung bei allen deutschen herzchirurgischen Zentren (n = 79) durchgeführt. Befragt wurden jeweils der Klinikdirektor, der Oberarzt und die Pflegeleitung der Intensivstation (n = 237 Fragebögen).

Ergebnisse

Es wurden 86 von 237 (36,3 %) Fragebögen beantwortet. Medizinische Gründe, die bei der Entscheidungsfindung zur Therapiezieländerung (Therapiebegrenzung und Therapieabbruch) beitragen, waren: kraniale Computertomographie (CCT) mit infauster Prognose (91,9 %), Multiorganversagen (70,9 %) und Versagen einer kardialen Assist-Device-Therapie (69,8 %). Bezüglich der ethischen Kriterien wurden eine schlechte Lebensqualität (48,8 %) sowie der mutmaßliche Patientenwille (40,7 %) angegeben. Die 3 unterschiedlichen Berufsgruppen zeigten sowohl bei der Beurteilung einiger medizinischer und ethischer Kriterien als auch in der Involvierung in den Entscheidungsprozess signifikante Unterschiede.

Schlussfolgerungen

Medizinische Gründe, die bei kritisch kranken kardiochirurgischen Patienten bei der Entscheidungsfindung zur Therapiezieländerung mit ausschlaggebend sind, waren eine CCT mit infauster Prognose, ein Multiorganversagen und ein Versagen einer kardialen Assist-Device-Therapie. Weitere Studien sind notwendig, um diese schwerwiegende Fragestellung zufriedenstellend beantworten zu können.

Abstract

Background

Ethical and medical criteria in the decision-making process of withholding or withdrawal of life support therapy in critically ill patients present a great challenge in intensive care medicine.

Objectives

The purpose of this work was to assess medical and ethical criteria that influence the decision-making process for changing the aim of therapy in critically ill cardiac surgery patients.

Materials and methods

A questionnaire was distributed to all German cardiac surgery centers (n = 79). All clinical directors, intensive care unit (ICU) consultants and ICU head nurses were asked to complete questionnaires (n = 237).

Results

In all, 86 of 237 (36.3 %) questionnaires were returned. Medical reasons which influence the decision-making process for changing the aim of therapy were cranial computed tomography (cCT) with poor prognosis (91.9 %), multi-organ failure (70.9 %), and failure of assist device therapy (69.8 %). Concerning ethical reasons, poor expected quality of life (48.8 %) and the presumed patient's wishes (40.7 %) were reported. There was a significant difference regarding the perception of the three different professional groups concerning medical and ethical criteria as well as the involvement in the decision-making process.

Conclusion

In critically ill cardiac surgery patients, medical reasons which influence the decision-making process for changing the aim of therapy included cCT with poor prognosis, multi-organ failure, and failure of assist device therapy. Further studies are mandatory in order to be able to provide adequate answers to this difficult topic.

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Authors and Affiliations

  1. Zentrum Operative Medizin, Klinik und Poliklinik für Thorax-, Herz- und Thorakale Gefäßchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland

    C. Schimmer, K. Hamouda, M. Oezkur, S.-P. Sommer, M. Leistner & R. Leyh

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  1. C. Schimmer
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  2. K. Hamouda
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Correspondence to C. Schimmer.

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C. Schimmer, K. Hamouda, M. Oezkur, S.-P. Sommer, M. Leistner und R. Leyh geben an, dass kein Interessenkonflikt besteht.

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M. Buerke, Siegen

Dieser Beitrag basiert auf einer englischsprachigen Originalarbeit [26] und ist als Update für die Zeitschrift Medizinische Klinik – Intensivmedizin und Notfallmedizin zu werten.

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Schimmer, C., Hamouda, K., Oezkur, M. et al. Begrenzung und Abbruch lebenserhaltender Maßnahmen bei kritisch kranken kardiochirurgischen Patienten. Med Klin Intensivmed Notfmed 111, 92–97 (2016). https://doi.org/10.1007/s00063-015-0045-8

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  • DOI: https://doi.org/10.1007/s00063-015-0045-8

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