Outcome of Patients who Have Therapy Withheld or Withdrawn in ICU

Abstract

Many deaths among patients treated in intensive care units (ICUs) occur following the withdrawal or withholding of life support. Following limitation of life support, most of these patients die in the ICU or ward after the decision to limit life support is made, although some may survive to hospital discharge. This study described the characteristics of patients who had life support limitations in ICU and their subsequent in-hospital and out-of-hospital survival using linked data from the state's death registry. Among 26,019 ICU admissions between 1987 and 2002 there were 396 patients (1.5%) who had life support limitations. The hospital mortality of the patients who had life support limitations was 97.7% and this accounted for 16.2% of the hospital mortality of all ICU admissions. Of the 396 patients who had life support limitations, 315 patients (79.5%) died in the ICU, 72 patients (18.2%) died in the wards and nine patients (2.3%) were discharged from hospital. Of these nine patients who survived to hospital discharge, four died within 10 days of hospital discharge and a further two died within six months. There were two patients, both with significant neurological disabilities at hospital discharge, who survived for longer than three years after hospital discharge. Long-term survival in critically ill patients who had life support limitations was very rare in this ICU.