Ernest van Veen1, Mathieu van der Jagt2, Giuseppe Citerio3, Nino Stocchetti4, Jelle L Epker5, Diederik Gommers6, Lex Burdorf7, David K Menon8, Andrew I R Maas9, Hester F Lingsma10, Erwin J O Kompanje11. 1. Department of Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Medical Ethics and Philosophy of Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands. Electronic address: e.vanveen.1@erasmusmc.nl. 2. Department of Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands. Electronic address: m.vanderjagt@erasmusmc.nl. 3. School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy; San Gerardo Hospital, ASST-Monza, Italy. Electronic address: giuseppe.citerio@unimib.it. 4. Department of Physiopathology and Transplantation, Milan University, Milan, Italy; Neuro ICU Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Milan, Italy. Electronic address: nino.stocchetti@policlinico.mi.it. 5. Department of Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands. Electronic address: j.epker@erasmusmc.nl. 6. Department of Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands. Electronic address: d.gommers@erasmusmc.nl. 7. Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands. Electronic address: a.burdurf@erasmusmc.nl. 8. Department of Anaesthesia, University of Cambridge, Cambridge, United Kingdom. Electronic address: dkm13@cam.ac.uk. 9. Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium. Electronic address: andrew.Maas@uza.be. 10. Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands. Electronic address: h.lingsma@erasmusmc.nl. 11. Department of Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Medical Ethics and Philosophy of Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands. Electronic address: e.j.o.kompanje@erasmusmc.nl.
Abstract
PURPOSE: We aimed to study variation regarding specific end-of-life (EoL) practices in the intensive care unit (ICU) in traumatic brain injury (TBI) patients. MATERIALS AND METHODS: Respondents from 67 hospitals participating in The Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study completed several questionnaires on management of TBI patients. RESULTS: In 60% of the centers, ≤50% of all patients with severe neurological damage dying in the ICU, die after withdrawal of life-sustaining measures (LSM). The decision to withhold/withdraw LSM was made following multidisciplinary consensus in every center. Legal representatives/relatives played a role in the decision-making process in 81% of the centers. In 82% of the centers, age played a role in the decision to withhold/withdraw LSM. Furthermore, palliative therapy was initiated in 79% of the centers after the decision to withdraw LSM was made. Last, withholding/withdrawing LSM was, generally, more often considered after more time had passed, in a patient with TBI, who remained in a very poor prognostic condition. CONCLUSION: We found variation regarding EoL practices in TBI patients. These results provide insight into variability regarding important issues pertaining to EoL practices in TBI, which can be useful to stimulate discussions on EoL practices, comparative effectiveness research, and, ultimately, development of recommendations.
PURPOSE: We aimed to study variation regarding specific end-of-life (EoL) practices in the intensive care unit (ICU) in traumatic brain injury (TBI) patients. MATERIALS AND METHODS: Respondents from 67 hospitals participating in The Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study completed several questionnaires on management of TBI patients. RESULTS: In 60% of the centers, ≤50% of all patients with severe neurological damage dying in the ICU, die after withdrawal of life-sustaining measures (LSM). The decision to withhold/withdraw LSM was made following multidisciplinary consensus in every center. Legal representatives/relatives played a role in the decision-making process in 81% of the centers. In 82% of the centers, age played a role in the decision to withhold/withdraw LSM. Furthermore, palliative therapy was initiated in 79% of the centers after the decision to withdraw LSM was made. Last, withholding/withdrawing LSM was, generally, more often considered after more time had passed, in a patient with TBI, who remained in a very poor prognostic condition. CONCLUSION: We found variation regarding EoL practices in TBI patients. These results provide insight into variability regarding important issues pertaining to EoL practices in TBI, which can be useful to stimulate discussions on EoL practices, comparative effectiveness research, and, ultimately, development of recommendations.
Authors: Cassidy Q B Mostert; Ranjit D Singh; Maxime Gerritsen; Erwin J O Kompanje; Gerard M Ribbers; Wilco C Peul; Jeroen T J M van Dijck Journal: Acta Neurochir (Wien) Date: 2022-01-31 Impact factor: 2.816
Authors: Ernest van Veen; Mathieu van der Jagt; Giuseppe Citerio; Nino Stocchetti; Diederik Gommers; Alex Burdorf; David K Menon; Andrew I R Maas; Erwin J O Kompanje; Hester F Lingsma Journal: Intensive Care Med Date: 2021-08-05 Impact factor: 17.440