Prehospital withholding and withdrawal of life-sustaining treatments. The French LATASAMU survey.
OBJECTIVE
To investigate the end-of-life decision process in patients managed by emergency physicians in the prehospital setting.


METHODS
A 40-item retrospective study about most recent end-of-life decision in the prehospital setting.


METHODS
1069 physicians (44.9%) from 192 French emergency mobile units.


RESULTS
A total of 816 (76.3%) physicians reported at least one prehospital end-of-life decision. Conscious patients were involved in 30.7% (54/176) and families in 63.6% of cases. The physician discussed the end-of-life decision with at least one other physician in 56.5% of cases. Perceived imminent death was the most frequently reported criterion (90.1%). Nearly four fifths of patients died before arrival at the hospital (78.8%). Factors independently associated with prehospital withdrawal decision included multiple trauma [odds ratio (OR) 5.7, 95% confidence interval (CI) 1.6-19.7], intubation (OR 3.9, 95% CI 2.3-6.5), chronic disease with severe heart failure (OR 2.8, 95% CI 1.5-5.2), acute event with postanoxic coma (OR 2.2, 95% CI 1.3-4.0), emergency physician from a teaching hospital (OR 2.1, 95% CI, 1.3-3.5), male patient (OR 1.9, 95% CI 1.1-3.3), and no sedation (OR 1.9, 95% CI 1.2-3.1). Prehospital withholding decisions were taken for 684 (88%) patients and withdrawing decisions for 12%.


CONCLUSIONS
Treatment withholding and withdrawal is common in the prehospital setting in France. These decisions remain highly questionable in this emergency context, in the absence of knowledge of the patient's medical history and of patients' and relatives' clear wishes concerning end-of-life decisions.
Ferrand
Edouard
E
Hôpital Henri Mondor, Service d'Anesthésie-Réanimation SAMU-SMUR 94, AP-HP, 51, avenue du Mal de Lattre de Tassigny, 94010 Créteil cedex, France. edouard.ferrand@hmn.aphp.fr
Marty
Jean
J
D003430:Cross-Sectional Studies; D003657:Decision Making; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005602:France; D006801:Humans; D007407:Interviews as Topic; D008020:Life Support Care; D016015:Logistic Models; D008297:Male; D018447:Medical Futility; D010166:Palliative Care; D010358:Patient Participation; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D028761:Withholding Treatment