Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Nov;17(4):295-301.
doi: 10.1177/1751143716647980. Epub 2016 May 5.

A case for stopping the early withdrawal of life sustaining therapies in patients with devastating brain injuries

Alex R Manara  1 , Ian Thomas  1 , Richard Harding  2   3
Affiliations

A case for stopping the early withdrawal of life sustaining therapies in patients with devastating brain injuries

Alex R Manara et al. J Intensive Care Soc. 2016 Nov.

Abstract

Early prognostication in patients with a devastating brain injury is not always accurate and can lead to inappropriate decisions. We present case histories to support the recent recommendations of the Neurocritical Care Society that treatment withdrawal decisions should be delayed by up to 72 h in these patients. Development of pathways incorporating these recommendations can improve prognostication, enhance end of life care given to these patients and their families, and increase the opportunities to explore the donation wishes of more patients. They may also standardise the approach to decision making in the same way as the recommendations for management of patients after out of hospital cardiac arrest have done.

Keywords: Devastating brain injury; critical care management; end of life care; neurocritical care; organ donation.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Suggested pathway for intubated patients with Devastating Brain Injury incorporating the recommendations of the Neuro-critical Care Society, as well as NICE guidance and NHSBT's strategy on best practice on identification and referral of potential organ donors. DBD: donation after brain death; DCD: donation after circulatory death; NHSBT: National Health Service Blood and Transplant; NICE: National Institute for Health and Care Excellence; WLST: withdrawal of life sustaining treatment.
Figure 2.
Figure 2.
CT of head of a patient showing the subdural haematoma with mass effect and midline shift.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Souter MJ, Blissitt PA, Blosser S, et al. Recommendations for the critical care management of devastating brain injury: prognostication, psychosocial, and ethical management. A position statement for healthcare professionals from the neurocritical care society. Neurocritical Care. 2015; 23: 4–13. - PubMed
    1. National Institute for Health and Clinical Excellence (December 2011). Organ donation for transplantation: improving donor identification and consent rates for deceased organ donation. Available at: http://www.nice.org.uk/guidance/cg135/resources/organ-donation-for-trans... (accessed 31st January 2016).
    1. Timely Identification and Referral of Potential Organ Donors. A strategy for implementation of best practice. NHS Blood and Transplant 2012. Available at: http://www.odt.nhs.uk/pdf/timely-identification-and-referral-potential-d... (accessed 31st January 2016).
    1. NHS Blood and Transplant 2013. Approaching the families of potential organ donors. Best practise guidance. Available at: http://www.ics.ac.uk/easysiteweb/getresource.axd?assetid=998&type=0&serv... (accessed 31st January 2016).
    1. Hemphill JC, 3rd, Newman J, Zhao S, et al. Hospital usage of early do-not-resuscitate orders and outcome after intracerebral hemorrhage. Stroke 2004; 35: 1130–1134. - PubMed

LinkOut - more resources