Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Avidan, A; Sprung, CL; Schefold, JC; Ricou, B; Hartog, CS; Nates, JL; Jaschinski, U; Lobo, SM; Joynt, GM; Lesieur, O; Weiss, M; Antonelli, M; Bülow, HH; Bocci, MG; Robertsen, A; Anstey, MH; Estébanez-Montiel, B; Lautrette, A; Gruber, A; Estella, A; Mullick, S; Sreedharan, R; Michalsen, A; Feldman, C; Tisljar, K; Posch, M; Ovu, S; Tamowicz, B; Demoule, A; DeKeyser, Ganz, F; Pargger, H; Noto, A; Metnitz, P; Zubek, L; de, la, Guardia, V; Danbury, CM; Szűcs, O; Protti, A; Filipe, M; Simpson, SQ; Green, C; Giannini, AM; Soliman, IW; Piras, C; Caser, EB; Hache-Marliere, M; Mentzelopoulos, SD, , ETHICUS-2, Study, Group.
Variations in end-of-life practices in intensive care units worldwide (Ethicus-2): a prospective observational study.
Lancet Respir Med. 2021; 9(10):1101-1110
Doi: 10.1016/S2213-2600(21)00261-7
Web of Science
PubMed
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- Co-Autor*innen der Med Uni Graz
- Metnitz Philipp
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- Abstract:
- 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 (14·6%) 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<0·001). Limitation of life-sustaining treatment occurred in 10 401 patients (11·8% of 87 951 ICU admissions and 80·9% of 12 850 in the study population). The most common limitation was withholding life-sustaining treatment (5661 [44·1%]), followed by withdrawing life-sustaining treatment (4680 [36·4%]). More treatment withdrawing was observed in Northern Europe (1217 [52·8%] of 2305) and Australia/New Zealand (247 [45·7%] of 541) than in Latin America (33 [5·8%] of 571) and Africa (21 [13·0%] of 162). Shortening of the dying process was uncommon across all regions (60 [0·5%]). 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 (5·1%). Failure of CPR occurred less frequently in Northern Europe (85 [3·7%] of 2305), Australia/New Zealand (23 [4·3%] of 541), and North America (78 [8·5%] of 918) than in Africa (106 [65·4%] of 162), Latin America (160 [28·0%] of 571), and Southern Europe (590 [22·5%] 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.
- Find related publications in this database (using NLM MeSH Indexing)
- Adult - administration & dosage
- Death - administration & dosage
- Decision Making - administration & dosage
- Humans - administration & dosage
- Intensive Care Units - administration & dosage
- Life Support Care - administration & dosage
- Prospective Studies - administration & dosage
- Terminal Care - administration & dosage