Limitation of life support treatments in Spanish Intensive Care Units: Analysis of the ETHICUS II study

Abstract

Objective: The aim of this study is to describe the results of Spanish ICUs in ETHICUS II study.

Design: Planned substudy of patients from ETHICUS II study.

Setting: 12 Spanish ICU.

Patients or participants: Patients admitted to Spanish ICU who died or in whom a limitation of life-sustaining treatment (LLST) was decided during a recruitment period of 6 months.

Interventions: Follow-up of patients was performed until discharge from the ICU and 2 months after the decision of LLST or death.

Main variables of interest: Demographic characteristics, clinical profile, type of decision of LLST, time and form in which it was adopted. Patients were classified into 4 categories according to the ETHICUS II study protocol: withholding or withdrawing life-sustaining therapy, active shortening of the dying process, failed cardiopulmonary resuscitation and patients with brain death.

Results: A total of 795 patients were analyzed; 129 patients died after CPR, 129 developed brain death. LLST was decided in 537 patients, 485 died in the ICU, 90.3%. The mean age was 66.19 years ± 14.36, 63.8% of male patients. In 221 (41%) it was decided to withdraw life-sustaining treatments and in 316 (59%) withholding life-sustaining treatments. Nineteen patients (2.38%) had advance living directives.

Conclusions: The predominant clinical profile when LTSV was established was male patients over 65 years with mostly cardiovascular comorbidity. We observed that survival was higher in LLST decisions involving withholding of treatments compared to those in which withdrawal was decided. Spain has played a leading role in both patient and ICU recruitment participating in this worldwide multicenter study.

Keywords: End of life; Final de vida; ICU; Limitación de tratamientos de soporte vital; Limitation of life support treatments; Omisión de tratamientos; Omission of treatments; Retirada de tratamientos; UCI; Withdrawal of treatments.