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Withdrawal of life-support in paediatric intensive care--a study of time intervals between discussion, decision and
Felix Oberender1, James Tibballs
1Intensive Care Unit, Royal Children's Hospital, Melbourne, Victoria, VIC 3052, Australia. felix.oberender@rch.org.au
Insights
The time to withdraw life-sustaining treatment and death varies greatly. Understanding these timeframes can improve end-of-life care and organ donation processes.
Area of Science:
- Pediatric critical care medicine
- End-of-life care research
- Thanatology
Background:
- Limited data exists on the temporal aspects of withdrawing life-sustaining treatment.
- This study addresses the time course of end-of-life decisions, treatment withdrawal, and death in a pediatric intensive care unit (PICU).
Purpose of the Study:
- To investigate the time intervals involved in the process of withdrawing life-sustaining treatment in a pediatric intensive care setting.
- To provide data that can inform clinical practice, parental guidance, and organ procurement strategies.
Main Methods:
- Prospective, observational study design.
- Conducted in the intensive care unit (ICU) of a tertiary children's hospital.
- Data collected over a 12-month period on 38 cases of withdrawal of life-sustaining treatment.
Main Results:
- Significant variability in time from initial discussion to decision-making (median 67.8 hours).
- Variability also observed from decision to treatment commencement (median 4.7 hours).
- Time to death after withdrawal varied (median 10 minutes), with 21% dying over 1 hour later.
Conclusions:
- Wide case-by-case variations exist at each stage of withdrawing life-sustaining treatment.
- Findings can aid medical management, leadership, parental support, and organ procurement planning.
- This knowledge is crucial for optimizing end-of-life care pathways in pediatric ICUs.
Background:
Scant information exists about the time-course of events during withdrawal of life-sustaining treatment. We investigated the time required for end-of-life decisions, subsequent withdrawal of life-sustaining treatment and the time to death.
Methods:
Prospective, observational study in the ICU of a tertiary paediatric hospital.
Results:
Data on 38 cases of withdrawal of life-sustaining treatment were recorded over a 12-month period (75% of PICU deaths). The time from the first discussion between medical staff and parents of the subject of withdrawal of life-sustaining treatment to parents and medical staff making the decision varied widely from immediate to 457 hours (19 days) with a median time of 67.8 hours (2.8 days). Large variations were subsequently also observed from the time of decision to actual commencement of the process ranging from 30 minutes to 47.3 hrs (2 days) with a median requirement of 4.7 hours. Death was apparent to staff at a median time of 10 minutes following withdrawal of life support varying from immediate to a maximum of 6.4 hours. Twenty-one per cent of children died more than 1 hour after withdrawal of treatment. Medical confirmation of death occurred at 0 to 35 minutes thereafter with the physician having left the bedside during withdrawal in 18 cases (48%) to attend other patients or to allow privacy for the family.
Conclusions:
Wide case-by-case variation in timeframes occurs at every step of the process of withdrawal of life-sustaining treatment until death. This knowledge may facilitate medical management, clinical leadership, guidance of parents and inform organ procurement after cardiac death.
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