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Vol. 48. Issue 5.
Pages 247-253 (May 2024)
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Vol. 48. Issue 5.
Pages 247-253 (May 2024)
Original article
Limitation of life support treatments in Spanish Intensive Care Units: Analysis of the ETHICUS II study
Limitación de tratamientos de soporte vital en Unidades de Cuidados Intensivos españolas: análisis del estudio ETHICUS II
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Ángel Estellaa,
Corresponding author
litoestella@hotmail.com

Corresponding author.
, Carolina Lagaresb, María José Furonesc, Pilar Martínez Lópezd, Noelia Isabel Lázaro Martíne, Belén Estebánezf, Jose Manuel Gómez Garcíag, Olga Rubioh, Bárbara Vidal Tejedori, Laura Galarzai, Manuel Palomo Navarroj, Vicent López Campsj, Mari Cruz Martínk, Juan Carlos Montejoe, Alexander Avidanl, Charles Sprungl, Grupo de Trabajo de Bioética de la Sociedad Española de Medicina Intensiva y Unidades Coronarias (SEMICYUC)
a Servicio de Medicina Intensiva, Hospital Universitario de Jerez, Departamento de Medicina, INiBICA, Facultad de Medicina de Cádiz, Cádiz, Spain
b Departamento de estadística, Grupo PAIDI CTS553, Universidad de Cádiz, Cádiz, Spain
c Servicio de Medicina Intensiva, Hospital Universitario Regional de Málaga, Málaga, Spain
d Servicio de Medicina Intensiva, Hospital Universitario Virgen de la Victoria, Málaga, Spain
e Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
f Servicio de Medicina Intensiva, Hospital Universitario de La Paz, Madrid, Spain
g Servicio de Medicina Intensiva, Hospital Universitario Gregorio Marañón, Madrid, Spain
h Servicio de Medicina Intensiva de Althaia Xarxa Assistencial Universitària, Manresa, Spain
i Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain
j Servicio de Medicina Intensiva, Hospital de Sagunto, Sagunto, Spain
k Servicio de Medicina Intensiva, Hospital de Torrejón de Ardoz, Madrid, Spain
l Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Table 1. Clinical characteristics of the study population.
Table 2. Reasons for admission.
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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
Limitation of life support treatments
ICU
Omission of treatments
Withdrawal of treatments
Resumen
Objetivo

Describir los resultados obtenidos en UCI españolas en el estudio ETHICUS II.

Diseño

Subestudio planificado de pacientes del ETHICUS II.

Ámbito

12 UCI españolas.

Pacientes o participantes

Pacientes que fallecieron o en los que se decidió una limitación de tratamiento de soporte vital (LTSV) durante un periodo de reclutamiento de 6 meses.

Intervenciones

Se realizó seguimiento hasta el alta de la UCI y 2 meses tras la decisión de LTSV o fallecimiento.

Variables de interés principales

Características demográficas, clínicas, tipo de decisión de LTSV. Se clasificaron en 4 categorías: omisión o retirada de tratamientos de soporte, acortar el proceso de morir, resucitación cardiopulmonar ineficaz y muerte cerebral.

Resultados

Un total de 12 UCI participaron en el ETHICUS II. Incluyeron 795 pacientes; 129 fallecieron tras realizarse RCP, 129 desarrollaron muerte encefálica. Se decidió LTSV en 537, fallecieron en UCI 485, el 90,3%. La edad media fue 66,19 años ± 14,36, el 63,8% fueron hombres. En un 41% se decidió retirada de tratamientos de soporte total y en un 59% se procedió a no iniciar medidas. Diecinueve pacientes (2,38%) disponían de documento de voluntades vitales anticipadas.

Conclusiones

El perfil clínico predominante cuando se estableció una LTSV fue el de pacientes varones mayores de 65 años con comorbilidad mayoritariamente cardiovascular.

La supervivencia fue mayor en las decisiones de LTSV que comprendían la omisión de tratamientos respecto a aquellas en las que se decidió la retirada.

España ha ocupado un papel destacado en este estudio multicéntrico de ámbito mundial.

Palabras clave:
Final de vida
Limitación de tratamientos de soporte vital
UCI
Omisión de tratamientos
Retirada de tratamientos

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