A five-step protocol for withholding and withdrawing of life support in an emergency department: an observational study.
OBJECTIVE
The objective of the study was to describe a five-step protocol for withholding and withdrawing of life support (WH/WDLS) in an emergency department (ED) for terminally ill patients.


METHODS
An observational study was conducted in ED of a general hospital.


METHODS
A total of 98 patients were admitted over a 1-year period.


METHODS
The healthcare team chose a pattern of treatment limitation on the basis of a five-step protocol for every patient, which comprised five groups: group 1: there was no limitation of care, group 2: do not resuscitate order was followed, group 3: administration of therapies without treating an acute organ failure, group 4: active withdrawal of all therapies except mechanical ventilation and group 5: active withdrawal of mechanical ventilation. All the patients received comfort care. The opinions of the patients and their families were collected.


RESULTS
Ninety-eight patients were included in the study (1.5% of admissions). Mean age was 82+/-13 years. An acute organ failure was observed at admission in 80 patients. Severe chronic disease was noted in 93 patients. Among the 98 patients, there were 14 patients in group 2, 65 in group 3, six in group 4 and 13 in group 5. The time interval between admission and WH/WDLS decision was 117+/-77 min and ED stay was 239+/-136 min. The outcome was death in ED (n=21), admission to a medical ward (n=71) or an intensive care unit (n=six). On day 30, 16 patients were still alive.


CONCLUSIONS
This five-step protocol could improve collaboration in the WH/WDLS decision-making process, while facilitating dialogue and transmission of information between staff and families.
Sedillot
Nicholas
N
Emergency Department, General Hospital of Bourg en Bresse, 900 Route de Paris, 01012 Bourg en Bresse, France. nichosed@yahoo.fr
Holzapfel
Laurent
L
Jacquet-Francillon
Thierry
T
Tafaro
Nathalie
N
Eskandanian
Ali
A
Eyraud
Sarah
S
Metton
Pierre
P
Prost
Sylvain
S
Serre
Patrice
P
Souton
Laure
L
D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005066:Euthanasia, Passive; D005602:France; D006801:Humans; D008875:Middle Aged; D010166:Palliative Care; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D016414:Resuscitation Orders; D013727:Terminal Care; D028761:Withholding Treatment