End-of-life care in the intensive care unit: the Irish Ethicus data
ABSTRACT
Objective: To study the frequency, rationale and process forwithholding (WH) and withdrawing (WD) life-sustainingtherapies in intensive care patients in Ireland.
Design: Prospective, observational study, comprising a subset of the European Ethicus Study.
Setting and participants: 122 patients who died or who had life-sustaining therapies limited in the ICU of a university hospital, 1 September 1999 to 30 June 2000.
Outcome measures and results: An end-of-life (EOL)treatment decision was made for 85/122 patients (69%).Forty-five (36%) had therapy withheld, 40 (33%) had itwithdrawn, 26 (21%) had unsuccessful cardiopulmonaryresuscitation, and 11 (10%) suffered brain death. The mediantime from ICU admission to death was 4.0 days for WHpatients and 2.9 days for WD patients (range, 10 minutes to123 days). The discussion to limit therapy was initiated by theICU doctor in 50 cases (59%), and involved families in 66cases (78%). Families initiated 9% of EOL discussions. Nursingstaff were involved in 98% of decisions. No patients werementally competent, but their wishes were known in 28% ofcases. The primary reason for limiting life-sustaining therapywas that the patient was unresponsive to maximum therapy(68% of patients). An EOL decision was made every 55 hoursduring “office hours” and every 120 hours during “on-call”working hours. Withholding was more frequent thanwithdrawing during “on call” periods.
Discussion: The frequency of withdrawal or withholding oftherapy in this Irish ICU is in line with current internationalpractice. The time to EOL decision-making is variable andrelatively short compared with that in the United States, butsimilar to that in Europe. Clinicians are the primary initiators ofthe EOL decision in Ireland, with little patient involvement.Family members are more likely to initiate an EOL decision thanin Europe. EOL decisions were usually made during “routine”working hours after significant consultation with all groups.
Crit Care Resusc 2006; 8: 315-320
