부산대학교 도서관

Byline: Philippe Conte (1), Denis Baron (1), David Trewick (1), Marie Dominique Touze (1), Celine Longo (1), Irshaad Vial (1), Danielle Yatim (1), Gille Potel (1) Abstract: Objectives Few studies have focused on decisions to withdraw or withhold life-support therapies in the emergency department. Our objectives were to identify clinical situations where life-support was withheld or withdrawn, the criteria used by physicians to justify their decisions, the modalities necessary to implement these decisions, patient disposition, and outcome. Design and setting Prospective unicenter survey in an Emergency Department of a tertiary care teaching hospital. Patients All non-trauma patients (n=119) for whom a decision to withhold or withdraw life-sustaining treatments was taken between January and September 1998. Main outcome measures Choice of criteria justifying the decision to withhold or withdraw life-sustaining treatments, time interval from ED admission to the decision type of decision implemented, outcome. Results Fourteen thousand eight hundred and seventy-five non-trauma patients were admitted during the study period, 119 were included, mean age 75+-13 years. Resuscitation procedures were instituted for 96 (80%) patients before a subsequent decision was taken. Physicians chose on average 6+-2 items to justify their decision the principal acute medical disorder and futility of care were the two criteria most often used. Median time interval to reach the decision was 187 min. Withdrawal involved 37% of patients and withholding 63% of patients. The family was involved in the decision-making process in 72% of patients. The median time interval from the decision to death was 16 h (5 min to 140 days). Conclusion Withdrawing and withholding life-support therapy involved elderly patients with underlying chronic cardiopulmonary disease or metastatic cancer or patients with acute non-treatable illness. Author Affiliation: (1) Service d'Accueil et d'Urgences, Centre Hospitalier Universitaire, 44093 , Nantes, France Article History: Registration Date: 24/09/2004 Received Date: 30/03/2004 Accepted Date: 15/09/2004 Online Date: 29/10/2004 Article note: An editorial regarding this article can be found in the same issue (http://dx.doi.org/10.1007/s00134-004-2476-1)