Abstract
Objectives
Few studies have focused on decisions to withdraw or withhold life-support therapies in the emergency department. Our objectives were to identify clinical situations where life-support was withheld or withdrawn, the criteria used by physicians to justify their decisions, the modalities necessary to implement these decisions, patient disposition, and outcome.
Design and setting
Prospective unicenter survey in an Emergency Department of a tertiary care teaching hospital.
Patients
All non-trauma patients (n=119) for whom a decision to withhold or withdraw life-sustaining treatments was taken between January and September 1998.
Main outcome measures
Choice of criteria justifying the decision to withhold or withdraw life-sustaining treatments, time interval from ED admission to the decision; type of decision implemented, outcome.
Results
Fourteen thousand eight hundred and seventy-five non-trauma patients were admitted during the study period, 119 were included, mean age 75±13 years. Resuscitation procedures were instituted for 96 (80%) patients before a subsequent decision was taken. Physicians chose on average 6±2 items to justify their decision; the principal acute medical disorder and futility of care were the two criteria most often used. Median time interval to reach the decision was 187 min. Withdrawal involved 37% of patients and withholding 63% of patients. The family was involved in the decision-making process in 72% of patients. The median time interval from the decision to death was 16 h (5 min to 140 days).
Conclusion
Withdrawing and withholding life-support therapy involved elderly patients with underlying chronic cardiopulmonary disease or metastatic cancer or patients with acute non-treatable illness.
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References
Stussman BJ (1997) National hospital ambulatory medical care survey: 1995 emergency department summary. Advance data from vital and health statistics; no. 285. National Center for Health Statistics, Hyattsville, Maryland, USA
Roupie E (1999) La mort aux urgences: enquête prospective préliminaire. In: Actualité en réanimation et urgences. Elsevier, pp. 281–289
Prendergast TJ, Claessens MT, Luce JM (1998) A national survey of end-of-life care for critically ill patients. Am J Respir Crit Care Med 158:1163–1167
Ferrand E, Robert R, Ingrand P for the French LATAREA group (2001) Withholding and withdrawal of life-support in intensive care units in France: a prospective survey. Lancet 357:9–14
Knauss WA, Zimmerman JE, Wagner DP (1981) APACHE: acute physiology and chronic health evaluation: a physiology based classification system. Crit Care Med 8:591–597
McCabe WR, Jackson GG (1962) Gram negative bacteremia. Arch Intern Med 110:83–91
Le Gall JR, Loirat P, Alperovitch A (1984) A simplified acute physiology score for ICU patients. Crit Care Med 12:975–977
Wrenn K, Brody SL (1992) Do-not-rescucitate orders in the emergency department. Am J med 92:129–133
Tardy B, Venet C, Zeni F, Berthet O, Viallon A, Lemaire F, Bertrand JC (2002) Death of terminally ill patients on a stretcher in the emergency department: a French specialty? Intens Care Med 28:1625–1628
Azoulay E, Pochard F, Chevret S, Vinsonneau C, Garrouste M, Cohen Y, Thuong M, Paugam C, Apperre C, De Cagny B, Brun F, Bornstain C, Parrot A, Thamion F, Lacherade JC, Bouffard Y, Le Gall JR, Herve C, Grassin M, Zittoun R, Schlemmer B, Dhainaut JF, PROTOCETIC Group (2001) Compliance with triage to intensive care recommendations. Crit Care Med 292:132–136
Marco CA, Larkin GL, Moskop JC, Derse AR (2000) Determination of “futility” in emergency medicine. Ann Emerg Med 35:604–612
Société de Réanimation de Langue Française (2002) Les limitations et arrêt de thérapeutique (s) active (s) en réanimation adulte. Réanimation 11:242–249
Société Francophone de Médecine d’Urgence (2003) Ethique et urgences Réflexions et recommandations de la Société Francophone de Médecine d’Urgence. JEUR 16:106–120
American College of Emergency Physicians (1999) Code of Ethics for Emergency physicians. Available at http://www.acep.org/1,1118,0.html. Accessed 28 March 2004
Iserson KV (1996) Withholding and withdrawing medical treatment: an emergency medicine perspective. Ann Emerg Med 28:51–54
Task force of the American College of Critical Care Medicine (1999) Society of Critical Care Medicine Guidelines for intensive care admission, discharge and triage. Crit Care Med 27:633–638
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An editorial regarding this article can be found in the same issue (http://dx.doi.org/10.1007/s00134-004-2476-1)
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Le Conte, P., Baron, D., Trewick, D. et al. Withholding and withdrawing life-support therapy in an Emergency Department: prospective survey. Intensive Care Med 30, 2216–2221 (2004). https://doi.org/10.1007/s00134-004-2475-2
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DOI: https://doi.org/10.1007/s00134-004-2475-2