title: [End-of-life decisions and practices in critically ill patients in the cardiac intensive care unit. A nationwide survey].
abstract: BACKGROUND
  Ethical and medical criteria in the decision-making process of withholding or withdrawal of life support therapy in critically ill patients present a great challenge in intensive care medicine.
  
  
  OBJECTIVE
  The purpose of this work was to assess medical and ethical criteria that influence the decision-making process for changing the aim of therapy in critically ill cardiac surgery patients.
  
  
  METHODS
  A questionnaire was distributed to all German cardiac surgery centers (n = 79). All clinical directors, intensive care unit (ICU) consultants and ICU head nurses were asked to complete questionnaires (n = 237).
  
  
  RESULTS
  In all, 86 of 237 (36.3 %) questionnaires were returned. Medical reasons which influence the decision-making process for changing the aim of therapy were cranial computed tomography (cCT) with poor prognosis (91.9 %), multi-organ failure (70.9 %), and failure of assist device therapy (69.8 %). Concerning ethical reasons, poor expected quality of life (48.8 %) and the presumed patient's wishes (40.7 %) were reported. There was a significant difference regarding the perception of the three different professional groups concerning medical and ethical criteria as well as the involvement in the decision-making process.
  
  
  CONCLUSIONS
  In critically ill cardiac surgery patients, medical reasons which influence the decision-making process for changing the aim of therapy included cCT with poor prognosis, multi-organ failure, and failure of assist device therapy. Further studies are mandatory in order to be able to provide adequate answers to this difficult topic.
authors.affiliation: Zentrum Operative Medizin, Klinik und Poliklinik für Thorax-, Herz- und Thorakale Gefäßchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland. schimmer_c@klinik.uni-wuerzburg.de.
authors.forename: C
authors.initials: C
authors.lastname: Schimmer
authors.affiliation: Zentrum Operative Medizin, Klinik und Poliklinik für Thorax-, Herz- und Thorakale Gefäßchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
authors.forename: K
authors.initials: K
authors.lastname: Hamouda
authors.affiliation: Zentrum Operative Medizin, Klinik und Poliklinik für Thorax-, Herz- und Thorakale Gefäßchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Oezkur
authors.affiliation: Zentrum Operative Medizin, Klinik und Poliklinik für Thorax-, Herz- und Thorakale Gefäßchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
authors.forename: S-P
authors.initials: SP
authors.lastname: Sommer
authors.affiliation: Zentrum Operative Medizin, Klinik und Poliklinik für Thorax-, Herz- und Thorakale Gefäßchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Leistner
authors.affiliation: Zentrum Operative Medizin, Klinik und Poliklinik für Thorax-, Herz- und Thorakale Gefäßchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
authors.forename: R
authors.initials: R
authors.lastname: Leyh
mesh_terms: D016223:Advance Directives / Q000941:ethics; D006348:Cardiac Surgical Procedures / Q000941:ethics* / Q000401:mortality; D002423:Cause of Death; D003422:Critical Care / Q000941:ethics*; D003661:Decision Support Techniques; D004992:Ethics, Medical; D005858:Germany; D006306:Health Surveys; D006801:Humans; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D008020:Life Support Care / Q000941:ethics*; D018447:Medical Futility / Q000941:ethics; D009102:Multiple Organ Failure / Q000401:mortality / Q000628:therapy; D010348:Patient Care Team / Q000941:ethics; D019724:Presumed Consent / Q000941:ethics; D011795:Surveys and Questionnaires; D028761:Withholding Treatment / Q000941:ethics*
keywords: Ethical aspects; Heart assist devices; Multi-organ failure; Social environment; Tomography