Abstract
BackgroundScant information exists about the time-course of events during withdrawal of life-sustaining treatment. We investigated the time required for end-of-life decisions, subsequent withdrawal of life-sustaining treatment and the time to death.MethodsProspective, observational study in the ICU of a tertiary paediatric hospital.ResultsData on 38 cases of withdrawal of life-sustaining treatment were recorded over a 12-month period (75% of PICU deaths). The time from the first discussion between medical staff and parents of the subject of withdrawal of life-sustaining treatment to parents and medical staff making the decision varied widely from immediate to 457 hours (19 days) with a median time of 67.8 hours (2.8 days). Large variations were subsequently also observed from the time of decision to actual commencement of the process ranging from 30 minutes to 47.3 hrs (2 days) with a median requirement of 4.7 hours. Death was apparent to staff at a median time of 10 minutes following withdrawal of life support varying from immediate to a maximum of 6.4 hours. Twenty-one per cent of children died more than 1 hour after withdrawal of treatment. Medical confirmation of death occurred at 0 to 35 minutes thereafter with the physician having left the bedside during withdrawal in 18 cases (48%) to attend other patients or to allow privacy for the family.ConclusionsWide case-by-case variation in timeframes occurs at every step of the process of withdrawal of life-sustaining treatment until death. This knowledge may facilitate medical management, clinical leadership, guidance of parents and inform organ procurement after cardiac death.
Highlights
Scant information exists about the time-course of events during withdrawal of life-sustaining treatment
We present the results of a 12-month prospective, observational study aiming to elucidate the time required for end-of-life decisions and subsequent withdrawal of life-sustaining treatment in an Australian paediatric intensive care unit
A prospective, observational study of deaths occurring in the Paediatric Intensive Care Unit (PICU) was conducted at the Royal Children’s Hospital (RCH) Melbourne, Australia
Summary
Scant information exists about the time-course of events during withdrawal of life-sustaining treatment. We investigated the time required for end-of-life decisions, subsequent withdrawal of life-sustaining treatment and the time to death. Withdrawal of life-sustaining treatment has become the predominant end-of-life scenario in children’s hospitals in the developed world. A variety of studies over the last two decades have highlighted the intensive care setting as the central, and in some instances nearly exclusive, place for making life and death decisions within a modern children’s hospital [1,2,3,4,5]. We present the results of a 12-month prospective, observational study aiming to elucidate the time required for end-of-life decisions and subsequent withdrawal of life-sustaining treatment in an Australian paediatric intensive care unit
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