TY - JOUR
TI - Variations in end-of-life practices in intensive care units worldwide
(Ethicus-2): a prospective observational study
AU - Avidan, Alexander
AU - Sprung, Charles L.
AU - Schefold, Joerg C. and
AU - Ricou, Bara
AU - Hartog, Christiane S.
AU - Nates, Joseph L. and
AU - Jaschinski, Ulrich
AU - Lobo, Suzana M.
AU - Joynt, Gavin M.
AU - Lesieur,
AU - Olivier
AU - Weiss, Manfred
AU - Antonelli, Massimo
AU - Bulow, Hans-Henrik
AU - and Bocci, Maria G.
AU - Robertsen, Annette
AU - Anstey, Matthew H. and
AU - Estebanez-Montiel, Belen
AU - Lautrette, Alexandre
AU - Gruber, Anastasiia
AU - and Estella, Angel
AU - Mullick, Sudakshina
AU - Sreedharan, Roshni and
AU - Michalsen, Andrej
AU - Feldman, Charles
AU - Tisljar, Kai
AU - Posch,
AU - Martin
AU - Ovu, Steven
AU - Tamowicz, Barbara
AU - Demoule, Alexandre and
AU - Ganz, Freda DeKeyser
AU - Pargger, Hans
AU - Noto, Alberto
AU - Metnitz,
AU - Philipp
AU - Zubek, Laszlo
AU - de la Guardia, Veronica
AU - Danbury,
AU - Christopher M.
AU - Szucs, Orsolya
AU - Protti, Alessandro
AU - Filipe,
AU - Mario
AU - Simpson, Steven Q.
AU - Green, Cameron
AU - Giannini, Alberto M.
AU - and Soliman, Ivo W.
AU - Piras, Claudio
AU - Caser, Eliana B. and
AU - Hache-Marliere, Manuel
AU - Mentzelopoulos, Spyros
AU - ETHICUS 2 Study
AU - Grp
JO - The Lancet Respiratory Medicine
PY - 2021
VL - 9
TODO - 10
SP - 1101-1110
PB - Elsevier Sci Ltd, Exeter, United Kingdom
SN - 2213-2600
TODO - 10.1016/S2213-2600(21)00261-7
TODO - null
TODO - Background End-of-life practices vary among intensive care units (ICUs)
worldwide. Differences can result in variable use of disproportionate or
non-beneficial life-sustaining interventions across diverse world
regions. This study investigated global disparities in end-of-life
practices. Methods In this prospective, multinational, observational
study, consecutive adult ICU patients who died or had a limitation of
life-sustaining treatment (withholding or withdrawing life-sustaining
therapy and active shortening of the dying process) during a 6-month
period between Sept 1, 2015, and Sept 30, 2016, were recruited from 199
ICUs in 36 countries. The primary outcome was the end-of-life practice
as defined by the end-of-life categories: withholding or withdrawing
life-sustaining therapy, active shortening of the dying process, or
failed cardiopulmonary resuscitation (CPR). Patients with brain death
were included in a separate predefined end-of-life category. Data
collection included patient characteristics, diagnoses, end-of-life
decisions and their timing related to admission and discharge, or death,
with comparisons across different regions. Patients were studied until
death or 2 months from the first limitation decision. Findings Of 87 951
patients admitted to ICU, 12 850 (14middot6%) were included in the
study population. The number of patients categorised into each of the
different end-of-life categories were significantly different for each
region (p<0middot001). Limitation of life-sustaining treatment occurred
in 10 401 patients (11middot8% of 87 951 ICU admissions and 80middot9%
of 12 850 in the study population). The most common limitation was
withholding life-sustaining treatment (5661 [44middot1%]), followed
by withdrawing life-sustaining treatment (4680 [36middot4%]). More
treatment withdrawing was observed in Northern Europe (1217
[52middot8%] of 2305) and Australia/New Zealand (247 [45middot7%]
of 541) than in Latin America (33 [5middot8%] of 571) and Africa (21
[13middot0%] of 162). Shortening of the dying process was uncommon
across all regions (60 [0middot5%]). One in five patients with
treatment limitations survived hospitalisation. Death due to failed CPR
occurred in 1799 (14%) of the study population, and brain death
occurred in 650 (5middot1%). Failure of CPR occurred less frequently in
Northern Europe (85 [3middot7%] of 2305), Australia/New Zealand (23
[4middot3%] of 541), and North America (78 [8middot5%] of 918)
than in Africa (106 [65middot4%] of 162), Latin America (160
[28middot0%] of 571), and Southern Europe (590 [22middot5%] of
2622). Factors associated with treatment limitations were region, age,
and diagnoses (acute and chronic), and country end-of-life legislation.
Interpretation Limitation of life-sustaining therapies is common
worldwide with regional variability. Withholding treatment is more
common than withdrawing treatment. Variations in type, frequency, and
timing of end-of-life decisions were observed. Recognising regional
differences and the reasons behind these differences might help improve
end-of-life care worldwide. Funding None. Copyright (c) 2021 Elsevier
Ltd. All rights reserved.
ER -