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Prehospital withholding and withdrawal of life-sustaining treatments. The French LATASAMU Survey

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Abstract

Objective

To investigate the end-of-life decision process in patients managed by emergency physicians in the prehospital setting.

Design

A 40-item retrospective study about most recent end-of-life decision in the prehospital setting.

Patients and participants

1069 physicians (44.9%) from 192 French emergency mobile units.

Measurements and results

A total of 816 (76.3%) physicians reported at least one prehospital end-of-life decision. Conscious patients were involved in 30.7% (54/176) and families in 63.6% of cases. The physician discussed the end-of-life decision with at least one other physician in 56.5% of cases. Perceived imminent death was the most frequently reported criterion (90.1%). Nearly four fifths of patients died before arrival at the hospital (78.8%). Factors independently associated with prehospital withdrawal decision included multiple trauma [odds ratio (OR) 5.7, 95% confidence interval (CI) 1.6–19.7], intubation (OR 3.9, 95% CI 2.3–6.5), chronic disease with severe heart failure (OR 2.8, 95% CI 1.5–5.2), acute event with postanoxic coma (OR 2.2, 95% CI 1.3–4.0), emergency physician from a teaching hospital (OR 2.1, 95% CI, 1.3–3.5), male patient (OR 1.9, 95% CI 1.1–3.3), and no sedation (OR 1.9, 95% CI 1.2–3.1). Prehospital withholding decisions were taken for 684 (88%) patients and withdrawing decisions for 12%.

Conclusions

Treatment withholding and withdrawal is common in the prehospital setting in France. These decisions remain highly questionable in this emergency context, in the absence of knowledge of the patient's medical history and of patients' and relatives' clear wishes concerning end-of-life decisions.

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Acknowledgements

We are indebted to François Lemaire and Christian Brun-Buisson for helpful advice in preparation of this report, their criticisms and comments on the manuscript. We thank Patricia Jabre for help in selecting the statistical models; Antoinette Wolfe to helpful advice in preparation of this report; Sylvain Fernandez-Curiel for conducting the interviews and for his advice in developing this study design; Sébastien Boyer (Sigillat Institute) for his assistance in analysis of the data; and Claire Vincent-Genod for research assistance. We are grateful for the contribution of all the physicians whose dedicated efforts ensured the high quality of the data. The investigators who participated in the French LATASAMU Group are listed in the electronic supplementary material.

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Authors and Affiliations

  1. Service d’Anesthésie–Réanimation SAMU–SMUR 94, Hôpital Henri Mondor, AP-HP, 51, avenue du Mal de Lattre de Tassigny, 94010, Créteil cedex, France

    Edouard Ferrand & Jean Marty

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  1. Edouard Ferrand
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  2. Jean Marty
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Corresponding author

Correspondence to Edouard Ferrand.

Additional information

Contributors: E. Ferrand: conception and design, analysis and interpretation of the data, drafting of the article; J. Marty: critical revision of the article for important intellectual content. The authors wrote this article for the French LATASAMU Group

Conflict of interest statement: We declare that we have no conflict of interest

Sources of support: none

This article is discussed in the editorial available at: http://dx.doi.org/10.1007/s00134-006-0293-4

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Ferrand, E., Marty, J. Prehospital withholding and withdrawal of life-sustaining treatments. The French LATASAMU Survey. Intensive Care Med 32, 1498–1505 (2006). https://doi.org/10.1007/s00134-006-0292-5

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  • DOI: https://doi.org/10.1007/s00134-006-0292-5

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