Occurrence and timing of withdrawal of life-sustaining measures in traumatic brain injury patients: a CENTER-TBI study
Creators: name: Van Der Jagt, Mathieu
name: Citerio, Giuseppe
name: Stocchetti, Nino
name: Gommers, Diederik
name: Burdorf, Alex
name: Menon, David K.
name: Maas, Andrew I. R.
name: Kompanje, Erwin J. O.
name: Lingsma, Hester F.
name: Åkerlund, Cecilia
name: Amrein, Krisztina
name: Andelic, Nada
name: Andreassen, Lasse
name: Anke, Audny
name: Antoni, Anna
name: Audibert, Gérard
name: Azouvi, Philippe
name: Azzolini, Maria Luisa
name: Bartels, Ronald
name: Barzó, Pál
name: Beauvais, Romuald
name: Beer, Ronny
name: Bellander, Bo-Michael
name: Belli, Antonio
name: Benali, Habib
name: Berardino, Maurizio
name: Beretta, Luigi
name: Blaabjerg, Morten
name: Bragge, Peter
name: Brazinova, Alexandra
name: Brinck, Vibeke
name: Brooker, Joanne
name: Brorsson, Camilla
name: Buki, Andras
name: Bullinger, Monika
name: Cabeleira, Manuel
name: Caccioppola, Alessio
name: Calappi, Emiliana
name: Calvi, Maria Rosa
name: Cameron, Peter
name: Lozano, Guillermo Carbayo
name: Carbonara, Marco
name: Cavallo, Simona
name: Chevallard, Giorgio
name: Chieregato, Arturo
name: Clusmann, Hans
name: Coburn, Mark
name: Coles, Jonathan
name: Cooper, Jamie D.
name: Correia, Marta
name: Čović, Amra
name: Curry, Nicola
name: Czeiter, Endre
name: Czosnyka, Marek
name: Fizelier, Claire Dahyot
name: Dark, Paul
name: Dawes, Helen
name: De Keyser, Véronique
name: Degos, Vincent
name: Corte, Francesco Della
name: Den Boogert, Hugo
name: Depreitere, Bart
name: Đilvesi, Đula
name: Dixit, Abhishek
name: Donoghue, Emma
name: Dreier, Jens
name: Dulière, Guy Loup
name: Ercole, Ari
name: Esser, Patrick
name: Ezer, Erzsébet
name: Fabricius, Martin
name: Feigin, Valery L.
name: Foks, Kelly
name: Frisvold, Shirin
name: Furmanov, Alex
name: Gagliardo, Pablo
name: Galanaud, Damien
name: Gantner, Dashiell
name: Gao, Guoyi
name: George, Pradeep
name: Ghuysen, Alexandre
name: Giga, Lelde
name: Glocker, Ben
name: Golubovic, Jagoš
name: Gomez, Pedro A.
name: Gratz, Johannes
name: Gravesteijn, Benjamin
name: Grossi, Francesca
name: Gruen, Russell L.
name: Gupta, Deepak
name: Haagsma, Juanita A.
name: Haitsma, Iain
name: Helbok, Raimund
name: Helseth, Eirik
name: Horton, Lindsay
name: Huijben, Jilske
name: Hutchinson, Peter J.
name: Jacobs, Bram
name: Jankowski, Stefan
name: Jarrett, Mike
name: Jiang, Ji Yao
name: Johnson, Faye
name: Jones, Kelly
name: Karan, Mladen
name: Kolias, Angelos G.
name: Kompanje, Erwin
name: Kondziella, Daniel
name: Kornaropoulos, Evgenios
name: Koskinen, Lars Owe
name: Kovács, Noémi
name: Kowark, Ana
name: Lagares, Alfonso
name: Lanyon, Linda
name: Laureys, Steven
name: Lecky, Fiona
name: Ledoux, Didier
name: Lefering, Rolf
name: Legrand, Valerie
name: Lejeune, Aurelie
name: Levi, Leon
name: Lightfoot, Roger
name: Lingsma, Hester
name: Castaño, Ana M. León
name: Maegele, Marc
name: Majdan, Marek
name: Manara, Alex
name: Manley, Geoffrey
name: Martino, Costanza
name: Maréchal, Hugues
name: Mattern, Julia
name: McMahon, Catherine
name: Melegh, Béla
name: Menon, David
name: Menovsky, Tomas
name: Mikolic, Ana
name: Misset, Benoit
name: Muraleedharan, Visakh
name: Murray, Lynnette
name: Negru, Ancuta
name: Nelson, David
name: Newcombe, Virginia
name: Nieboer, Daan
name: Nyirádi, József
name: Olubukola, Otesile
name: Oresic, Matej
name: Ortolano, Fabrizio
name: Palotie, Aarno
name: Parizel, Paul M.
name: Payen, Jean François
name: Perera, Natascha
name: Perlbarg, Vincent
name: Persona, Paolo
name: Peul, Wilco
name: Piippo-Karjalainen, Anna
name: Pirinen, Matti
name: Pisica, Dana
name: Ples, Horia
name: Polinder, Suzanne
name: Pomposo, Inigo
name: Posti, Jussi P.
name: Puybasset, Louis
name: Radoi, Andreea
name: Ragauskas, Arminas
name: Raj, Rahul
name: Rambadagalla, Malinka
name: Helmrich, Isabel Retel
name: Rhodes, Jonathan
name: Richardson, Sylvia
name: Richter, Sophie
name: Ripatti, Samuli
name: Rocka, Saulius
name: Roe, Cecilie
name: Roise, Olav
name: Rosand, Jonathan
name: Rosenfeld, Jeffrey V.
name: Rosenlund, Christina
name: Rosenthal, Guy
name: Rossaint, Rolf
name: Rossi, Sandra
name: Rueckert, Daniel
name: Rusnák, Martin
name: Sahuquillo, Juan
name: Sakowitz, Oliver
name: Porras, Renan Sanchez
name: Sandor, Janos
name: Schäfer, Nadine
name: Schmidt, Silke
name: Schoechl, Herbert
name: Schoonman, Guus
name: Schou, Rico Frederik
name: Schwendenwein, Elisabeth
name: Sewalt, Charlie
name: Skandsen, Toril
name: Smielewski, Peter
name: Sorinola, Abayomi
name: Stamatakis, Emmanuel
name: Stanworth, Simon
name: Stevens, Robert
name: Stewart, William
name: Steyerberg, Ewout W.
name: Sundström, Nina
name: Takala, Riikka
name: Tamás, Viktória
name: Tamosuitis, Tomas
name: Taylo, Mark Steven
name: Ao, Braden Te
name: Tenovuo, Olli
name: Theadom, Alice
name: Thomas, Matt
name: Tibboel, Dick
name: Timmers, Marjolein
name: Tolias, Christos
name: Trapani, Tony
name: Tudora, Cristina Maria
name: Unterberg, Andreas
name: Vajkoczy, Peter
name: Vallance, Shirley
name: Valeinis, Egils
name: Vámos, Zoltán
name: Van Der Steen, Gregory
name: Van Der Naalt, Joukje
name: Van Dijck, Jeroen T. J. M.
name: Van Essen, Thomas A.
name: Van Hecke, Wim
name: Van Heugten, Caroline
name: Van Praag, Dominique
name: Van Veen, Ernest
name: Vyvere, Thijs Vande
name: Van Wijk, Roel P. J.
name: Vargiolu, Alessia
name: Vega, Emmanuel
name: Velt, Kimberley
name: Verheyden, Jan
name: Vespa, Paul M.
name: Vik, Anne
name: Vilcinis, Rimantas
name: Volovici, Victor
name: Von Steinbüchel, Nicole
name: Voormolen, Daphne
name: Vulekovic, Petar
name: Wang, Kevin K. W.
name: Wiegers, Eveline
name: Williams, Guy
name: Wilson, Lindsay
name: Winzeck, Stefan
name: Wolf, Stefan
name: Yang, Zhihui
name: Ylén, Peter
name: Younsi, Alexander
name: Zeiler, Frederick A.
name: Zelinkova, Veronika
name: Ziverte, Agate
name: Zoerle, Tommaso
Publisher: name: Apollo - University of Cambridge Repository
Year: 2021
Subjects: Original
Traumatic brain injury
Critical care
Intensive care unit
WLSM

description: Funder: National Institute for Health Research (UK)
description: Abstract: Background: In patients with severe brain injury, withdrawal of life-sustaining measures (WLSM) is common in intensive care units (ICU). WLSM constitutes a dilemma: instituting WLSM too early could result in death despite the possibility of an acceptable functional outcome, whereas delaying WLSM could unnecessarily burden patients, families, clinicians, and hospital resources. We aimed to describe the occurrence and timing of WLSM, and factors associated with timing of WLSM in European ICUs in patients with traumatic brain injury (TBI). Methods: The CENTER-TBI Study is a prospective multi-center cohort study. For the current study, patients with traumatic brain injury (TBI) admitted to the ICU and aged 16 or older were included. Occurrence and timing of WLSM were documented. For the analyses, we dichotomized timing of WLSM in early (&lt; 72 h after injury) versus later (≥ 72 h after injury) based on recent guideline recommendations. We assessed factors associated with initiating WLSM early versus later, including geographic region, center, patient, injury, and treatment characteristics with univariable and multivariable (mixed effects) logistic regression. Results: A total of 2022 patients aged 16 or older were admitted to the ICU. ICU mortality was 13% (n = 267). Of these, 229 (86%) patients died after WLSM, and were included in the analyses. The occurrence of WLSM varied between regions ranging from 0% in Eastern Europe to 96% in Northern Europe. In 51% of the patients, WLSM was early. Patients in the early WLSM group had a lower maximum therapy intensity level (TIL) score than patients in the later WLSM group (median of 5 versus 10) The strongest independent variables associated with early WLSM were one unreactive pupil (odds ratio (OR) 4.0, 95% confidence interval (CI) 1.3–12.4) or two unreactive pupils (OR 5.8, CI 2.6–13.1) compared to two reactive pupils, and an Injury Severity Score (ISS) if over 41 (OR per point above 41 = 1.1, CI 1.0–1.1). Timing of WLSM was not significantly associated with region or center. Conclusion: WLSM occurs early in half of the patients, mostly in patients with severe TBI affecting brainstem reflexes who were severely injured. We found no regional or center influences in timing of WLSM. Whether WLSM is always appropriate or may contribute to a self-fulfilling prophecy requires further research and argues for reluctance to institute WLSM early in case of any doubt on prognosis.