Changes in End-of-Life Practices in European Intensive Care Units From 1999 to 2016
Status PubMed-not-MEDLINE Language English Country United States Media print
Document type Journal Article
PubMed
31577037
PubMed Central
PMC6777263
DOI
10.1001/jama.2019.14608
PII: 2752581
Knihovny.cz E-resources
- Publication type
- Journal Article MeSH
IMPORTANCE: End-of-life decisions occur daily in intensive care units (ICUs) around the world, and these practices could change over time. OBJECTIVE: To determine the changes in end-of-life practices in European ICUs after 16 years. DESIGN, SETTING, AND PARTICIPANTS: Ethicus-2 was a prospective observational study of 22 European ICUs previously included in the Ethicus-1 study (1999-2000). During a self-selected continuous 6-month period at each ICU, consecutive patients who died or had any limitation of life-sustaining therapy from September 2015 until October 2016 were included. Patients were followed up until death or until 2 months after the first treatment limitation decision. EXPOSURES: Comparison between the 1999-2000 cohort vs 2015-2016 cohort. MAIN OUTCOMES AND MEASURES: End-of-life outcomes were classified into 5 mutually exclusive categories (withholding of life-prolonging therapy, withdrawing of life-prolonging therapy, active shortening of the dying process, failed cardiopulmonary resuscitation [CPR], brain death). The primary outcome was whether patients received any treatment limitations (withholding or withdrawing of life-prolonging therapy or shortening of the dying process). Outcomes were determined by senior intensivists. RESULTS: Of 13 625 patients admitted to participating ICUs during the 2015-2016 study period, 1785 (13.1%) died or had limitations of life-prolonging therapies and were included in the study. Compared with the patients included in the 1999-2000 cohort (n = 2807), the patients in 2015-2016 cohort were significantly older (median age, 70 years [interquartile range {IQR}, 59-79] vs 67 years [IQR, 54-75]; P < .001) and the proportion of female patients was similar (39.6% vs 38.7%; P = .58). Significantly more treatment limitations occurred in the 2015-2016 cohort compared with the 1999-2000 cohort (1601 [89.7%] vs 1918 [68.3%]; difference, 21.4% [95% CI, 19.2% to 23.6%]; P < .001), with more withholding of life-prolonging therapy (892 [50.0%] vs 1143 [40.7%]; difference, 9.3% [95% CI, 6.4% to 12.3%]; P < .001), more withdrawing of life-prolonging therapy (692 [38.8%] vs 695 [24.8%]; difference, 14.0% [95% CI, 11.2% to 16.8%]; P < .001), less failed CPR (110 [6.2%] vs 628 [22.4%]; difference, -16.2% [95% CI, -18.1% to -14.3%]; P < .001), less brain death (74 [4.1%] vs 261 [9.3%]; difference, -5.2% [95% CI, -6.6% to -3.8%]; P < .001) and less active shortening of the dying process (17 [1.0%] vs 80 [2.9%]; difference, -1.9% [95% CI, -2.7% to -1.1%]; P < .001). CONCLUSIONS AND RELEVANCE: Among patients who had treatment limitations or died in 22 European ICUs in 2015-2016, compared with data reported from the same ICUs in 1999-2000, limitations in life-prolonging therapies occurred significantly more frequently and death without limitations in life-prolonging therapies occurred significantly less frequently. These findings suggest a shift in end-of-life practices in European ICUs, but the study is limited in that it excluded patients who survived ICU hospitalization without treatment limitations.
Clinic of Anaesthesiology University Hospital Medical School Ulm Germany
Critical Care Department The University of Texas MD Anderson Cancer Center Houston
Critical Care Medicine Tata Medical Center Kolkata India
Department of Anaesthesia and Intensive Care The Chinese University of Hong Kong Hong Kong China
Department of Anesthesia and Intensive Care Medicine Aarhus University Hospital Aarhus Denmark
Department of Anesthesiology and Intensive Care Holbaek University Hospital Zealand Region Denmark
Department of Anesthesiology and Intensive Care Medicine University of Liege Liege Belgium
Department of Intensive Care Medicine University of Ioannina Ioannina Greece
Department of Intensive Care Medicine VU Medical Center Amsterdam the Netherlands
Department of Intensive Care Royal Berkshire Hospital Berkshire United Kingdom
Department of Intensive Care University Medical Center Utrecht Utrecht the Netherlands
Division of Pediatric Anesthesia and Intensive Care ASST Spedali Civili Brescia Italy
General Intensive Care Unit Shaare Zedek Medical Center Jerusalem Israel
Inselspital Department of Intensive Care Medicine University of Bern Switzerland
Intensive Care Department Hospital S Antonio Centro Hospitalar do Porto Porto Portugal
Intensive Care Department University Hospital SAS of Jerez Jerez de la Frontera Spain
Intensive Care Medicine University Hospitals K U Leuven Leuven Belgium
Intensive Care Unit Hospital General Universitario de Castellón Castellón de la Plana Spain
Intensive Care Unit Hospital Universitario La Paz Madrid Spain
Intensive Care Unit Saint Louis General Hospital La Rochelle France
Mater Misericordiae University Hospital Intensive Care Unit Dublin Ireland
Medical Intensive Care University of Basel Hospital Basel Switzerland
The Hebrew University Hadassah School of Public Health Jerusalem Israel
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