Forgoing life support: how the decision is made in European pediatric intensive care units

Area of Science:

• Pediatric Intensive Care Medicine
• Medical Ethics
• Healthcare Management

Background:

• End-of-life care decisions in pediatric intensive care units (PICUs) are complex and vary significantly across regions.
• Understanding regional differences in forgoing life support practices is crucial for improving pediatric palliative care.
• Previous studies, such as Eurydice I, have highlighted these variations.

Purpose of the Study:

• To investigate the current practices and decision-making processes for forgoing life support in European PICUs.
• To compare end-of-life care practices across different European regions (France, Northern/Western Europe, Eastern/Central Europe).
• To identify trends in these practices over time by comparing with Eurydice I.

Main Methods:

• A multicenter, prospective study (Eurydice II) involving 45 PICUs across Europe.
• Data collection via questionnaires between November 2009 and April 2010.
• Analysis of decisions to forgo life-sustaining treatment in deceased children.

Main Results:

• The decision to forgo life support was made in 40.6% of deceased children, a higher rate than in Eurydice I (33%).
• Significant regional variations were observed: 38.2% in France, 60.0% in N/W Europe, and 0% in E/C Europe (P < 0.001).
• Decisions were made during formal meetings, documented, and parents were typically informed and present at death.

Conclusions:

• A trend towards standardization of end-of-life practices is evident in N/W European countries and France over the past decade.
• Practices in Eastern/Central European countries differ, with more deaths occurring after cardiopulmonary resuscitation failure.
• Increased parental involvement and information sharing were noted in France compared to Eurydice I.