Intensive Care Medicine

, Volume 41, Issue 6, pp 1014–1028 | Cite as

Predicting time to death after withdrawal of life-sustaining therapy

  • Laveena Munshi
  • Sonny Dhanani
  • Sam D. Shemie
  • Laura Hornby
  • Genevieve Gore
  • Jason ShahinEmail author
Systematic Review



Predicting time to death following the withdrawal of life-sustaining therapy is difficult. Accurate predictions may better prepare families and improve the process of donation after circulatory death.


We systematically reviewed any predictive factors for time to death after withdrawal of life support therapy.


Fifteen observational studies met our inclusion criteria. The primary outcome was time to death, which was evaluated to be within 60 min in the majority of studies (13/15). Additional time endpoints evaluated included time to death within 30, 120 min, and 10 h, respectively. While most studies evaluated risk factors associated with time to death, a few derived or validated prediction tools. Consistent predictors of time to death that were identified in five or more studies included the following risk factors: controlled ventilation, oxygenation, vasopressor use, Glasgow Coma Scale/Score, and brain stem reflexes. Seven unique prediction tools were derived, validated, or both across some of the studies. These tools, at best, had only moderate sensitivity to predicting the time to death. Simultaneous withdrawal of all support and physician opinion were only evaluated in more recent studies and demonstrated promising predictor capabilities.


While the risk factors controlled ventilation, oxygenation, vasopressors, level of consciousness, and brainstem reflexes have been most consistently found to be associated with time to death, the addition of novel predictors, such as physician opinion and simultaneous withdrawal of all support, warrant further investigation. The currently existing prediction tools are not highly sensitive. A more accurate and generalizable tool is needed to inform end-of-life care and enhance the predictions of donation after circulatory death eligibility.


Withholding treatment Life support care Death Time factors Donation after cardiac death 



Laveena Munshi receives funding from the Eliot Phillipson Clinician Scientist. Training Program, Department of Medicine, University of Toronto. Jason Shahin receives funding support from the Department of Medicine, McGill University Health Centre.

Conflicts of interest

The authors declare that they have no conflicts of interest. Sonny Dhanani is the Chief Medical Officer of Trillium Gift of Life Network. Sam Shemie is a medical advisor to the Canadian Blood Services.

Supplementary material

134_2015_3762_MOESM1_ESM.docx (22 kb)
Supplementary material 1 (DOCX 21 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • Laveena Munshi
    • 1
  • Sonny Dhanani
    • 2
    • 3
  • Sam D. Shemie
    • 4
  • Laura Hornby
    • 3
  • Genevieve Gore
    • 5
  • Jason Shahin
    • 6
    Email author
  1. 1.Interdepartmental Division of Critical Care Medicine, and Department of MedicineUniversity of Toronto, University Health Network and Mount Sinai HospitalTorontoCanada
  2. 2.Division of Pediatric Critical Care, Faculty of MedicineUniversity of OttawaOttawaCanada
  3. 3.Children’s Hospital of Eastern Ontario Research InstituteOttawaCanada
  4. 4.Pediatric Critical Care, Montreal Children’s Hospital, McGill University Health CentreMcGill UniversityMontrealCanada
  5. 5.Schulich Library of Science and EngineeringMcGill UniversityMontrealCanada
  6. 6.Department of Critical Care, Department of Medicine, Respiratory Division, Respiratory Epidemiology Clinical Research UnitMcGill University Health CentreMontrealCanada

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