title: Exploration of Withdrawal of Life-Sustaining Therapy in Canadian Intensive Care Units.
abstract: OBJECTIVE
  The process of controlled donation after circulatory death (cDCD) is strongly connected with the process of withdrawal of life-sustaining therapy. In addition to impacting cDCD success, actions comprising withdrawal of life-sustaining therapy have implications for quality of palliative care. We examined pilot study data from Canadian intensive care units to explore current practices of life-sustaining therapy withdrawal in nondonor patients and described variability in standard practice.
  
  
  METHODS
  Secondary analysis of observational data collected for Determination of Death Practices in Intensive Care pilot study.
  
  
  METHODS
  Four Canadian adult intensive care units.
  
  
  METHODS
  Patients ≥18 years in whom a decision to withdraw life-sustaining therapy was made and substitute decision makers consented to study participation. Organ donors were excluded.
  
  
  METHODS
  None.
  
  
  RESULTS
  Prospective observational data on interventions withdrawn, drugs administered, and timing of life-sustaining therapy withdrawal was available for 36 patients who participated in the pilot study. Of the patients, 42% died in ≤1 hour; median length of time to death varied between intensive care units (39-390 minutes). Withdrawal of life-sustaining therapy processes appeared to follow a general pattern of vasoactive drug withdrawal followed by withdrawal of mechanical ventilation and extubation in most sites but specific steps varied. Approaches to extubation and weaning of vasoactive drugs were not consistent. Protocols detailing the process of life-sustaining therapy withdrawal were available for 3 of 4 sites and also exhibited differences across sites.
  
  
  CONCLUSIONS
  Standard practice of life-sustaining therapy withdrawal appears to differ between selected Canadian sites. Variability in withdrawal of life-sustaining therapy may have a potential impact both on rates of cDCD success and quality of palliative care.
authors: Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada amandavb4@gmail.com.
authors: Amanda
authors: A
authors: van Beinum
authors: Bertram Loeb Research Consortium in Organ and Tissue Donation, University of Ottawa, Ottawa, Canada.
authors: Laura
authors: L
authors: Hornby
authors: Ottawa Hospital Research Institute Methods Center, Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada.
authors: Tim
authors: T
authors: Ramsay
authors: CHEO Research Institute, Ottawa, Canada.
authors: Roxanne
authors: R
authors: Ward
authors: Bertram Loeb Research Consortium in Organ and Tissue Donation, University of Ottawa, Ottawa, Canada Division of Critical Care, Montreal Children's Hospital, McGill University, Montréal, Canada.
authors: Sam D
authors: SD
authors: Shemie
authors: Bertram Loeb Research Consortium in Organ and Tissue Donation, University of Ottawa, Ottawa, Canada CHEO Research Institute, Ottawa, Canada Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada.
authors: Sonny
authors: S
authors: Dhanani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D003422:Critical Care / Q000379:methods*; D003643:Death; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008020:Life Support Care / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D013997:Time Factors; D028761:Withholding Treatment / Q000706:statistics & numerical data*
keywords: critical care; end-of-life care; extubation; tissue and organ procurement; ventilator weaning; withholding treatment