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BMC Emergency Medicine

, 11:12

First Online: 12 August 2011Received: 03 March 2011Accepted: 12 August 2011DOI: 10.1186-1471-227X-11-12

Cite this article as: Damghi, N., Belayachi, J., Aggoug, B. et al. BMC Emerg Med 2011 11: 12. doi:10.1186-1471-227X-11-12

Abstract

BackgroundWithdrawing and withholding life-support therapy WH-WD are undeniably integrated parts of medical activity. However, Emergency Department ED might not be the most appropriate place to give end-of life EOL care; the legal aspects and practices of the EOL care in emergency rooms are rarely mentioned in the medical literature and should be studied. The aims of this study were to assess frequency of situations where life-support therapies were withheld or withdrawn and modalities for implement of these decisions.

MethodA survey of patients who died in a Moroccan ED was performed. Confounding variables examined were: Age, gender, chronic underlying diseases, acute medical disorders, APACHE II score, Charlson Comorbidities Index, and Length of stay. If a decision of WH-WD was taken, additional data were collected: Type of decision; reasons supporting the decision, modalities of WH-WD, moment, time from ED admission to decision, and time from processing to withhold or withdrawal life-sustaining treatment to death. Individuals who initiated single emergency physician, medical staff, and were involved in the decision nursing staff, patients, and families, and documentation of the decision in the medical record.

Results177 patients who died in ED between November 2009 and March 2010 were included. Withholding and withdrawing life-sustaining treatment was applied to 30.5% of all patients who died. Therapies were withheld in 24.2% and were withdrawn in 6.2%. The most reasons for making these decisions were; absence of improvement following a period of active treatment 61.1%, and expected irreversibility of acute disorder in the first 24 h 42.6%. The most common modalities withheld or withdrawn life-support therapy were mechanical ventilation 17%, vasopressor and inotrops infusion 15.8%. Factors associated with WH-WD decisions were older age OR = 1.1; 95%IC = 1.01-1.07; P = 0.001, neurological acute medical disorders OR = 4.1; 95%IC = 1.48-11.68; P = 0.007, malignancy OR = 7.7; 95%IC = 1.38-8.54; P = 0.002 and cardiovascular OR = 3.4;95%IC = 2.06-28.5;P = 0.008 chronic underlying diseases.

ConclusionLife-sustaining treatment were frequently withheld or withdrawn from elderly patients with underlying chronic cardiovascular disease or metastatic cancer or patients with acute neurological medical disorders in a Moroccan ED. Religious beliefs and the lack of guidelines and official Moroccan laws could explain the ethical limitations of the decision-making process recorded in this study.

KeywordsEmergency life-sustaining treatment withdrawal withholding AbbreviationsEDEmergency department

APACHE IIAcute Physiology and Chronic Health Evaluation II

CCICharlson Comorbidities Index

WHwithholding

WDwithdrawing

IVintravenous

hhours

IQRinterquartile range

ORodds ratio

CIconfidence Interval

ICUintensive care unit

EOLend of life.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-227X-11-12 contains supplementary material, which is available to authorized users.

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Author: Nada Damghi - Jihane Belayachi - Badria Aggoug - Tarek Dendane - Khalid Abidi - Naoufel Madani - Aicha Zekraoui - Abdellati

Source: https://link.springer.com/







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