OBJECTIVE: To investigate whether observable differences exist between patterns of withdrawal of life-sustaining measures (WLSM) for patients eligible for donation after circulatory death (DCD) in whom donation was attempted compared with those patients in whom no donation attempts were made. SETTING: Adult intensive care units from 20 centres in Canada, the Czech Republic and the Netherlands. DESIGN: Secondary analysis of quantitative data collected as part of a large, prospective, cohort study (the Death Prediction and Physiology after Removal of Therapy study). PARTICIPANTS: Patients ≥18 years of age who died after a controlled WLSM in an intensive care unit. Patients were classified as not DCD eligible, DCD eligible with DCD attempted or DCD eligible but DCD was not attempted. PRIMARY AND SECONDARY OUTCOME MEASURES: The process of WLSM (timing and type and, if applicable, dosages of measures withdrawn, dosages of analgesics/sedatives) was compared between groups. RESULTS: Of the 635 patients analysed, 85% had either cardiovascular support stopped or were extubated immediately on WLSM. Of the DCD eligible patients, more were immediately extubated at the initiation of WLSM when DCD was attempted compared with when DCD was not attempted (95% vs 61%, p<0.0001). Initiation of WLSM with the immediate cessation of cardiovascular measures or early extubation was associated with earlier time to death, even after adjusting for confounders (OR 2.94, 95% CI 1.39 to 6.23, at 30 min). Other than in a few patients who received propofol, analgesic and sedative dosing after WLSM between DCD attempted and DCD eligible but not attempted patients was not significantly different. All patients died. CONCLUSIONS: Patients in whom DCD is attempted may receive a different process of WLSM. This highlights the need for a standardised and transparent process for end-of-life care across the spectrum of critically ill patients and potential organ donors.

3rd Faculty of Medicine Charles University Praha Czech Republic

CHEO Ottawa Ontario Canada

Critical Pediatric Critical Care Medicine Children's Hospital of Eastern Ontario Ottawa Ontario Canada

Deparment of Intensive Care Medicine Maastricht University Medical Centre Maastricht The Netherlands

Department of Pediatrics University of Ottawa Ottawa Ontario Canada

Division of Critical Care Department of Pediatrics Montreal Childrens Hospital Montreal Québec Canada

Division of Critical Care Respiratory Epidemiology and Clinical Research Unit McGill University Faculty of Medicine Montreal Québec Canada

FNKV University Hospital Prague Czech Republic

Heart and Vascular Center Maastricht The Netherlands

Maastricht University Medical Centre Maastricht The Netherlands

Ottawa Hospital Research Institute Ottawa Ontario Canada

Research Institute of the McGill University Health Centre Montreal Québec Canada

System Development Canadian Blood Services Organ Donation and Transplantation Ottawa Ontario Canada

System Development Canadian Blood Services Ottawa Ontario Canada

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