PMID- 21838861
OWN - NLM
STAT- MEDLINE
DCOM- 20111213
LR  - 20211020
IS  - 1471-227X (Electronic)
IS  - 1471-227X (Linking)
VI  - 11
DP  - 2011 Aug 12
TI  - Withholding and withdrawing life-sustaining therapy in a Moroccan Emergency 
      Department: an observational study.
PG  - 12
LID - 10.1186/1471-227X-11-12 [doi]
AB  - BACKGROUND: Withdrawing and withholding life-support therapy (WH/WD) are 
      undeniably integrated parts of medical activity. However, Emergency Department 
      (ED) might not be the most appropriate place to give end-of life (EOL) care; the 
      legal aspects and practices of the EOL care in emergency rooms are rarely 
      mentioned in the medical literature and should be studied. The aims of this study 
      were to assess frequency of situations where life-support therapies were withheld 
      or withdrawn and modalities for implement of these decisions. METHOD: A survey of 
      patients who died in a Moroccan ED was performed. Confounding variables examined 
      were: Age, gender, chronic underlying diseases, acute medical disorders, APACHE 
      II score, Charlson Comorbidities Index, and Length of stay. If a decision of 
      WH/WD was taken, additional data were collected: Type of decision; reasons 
      supporting the decision, modalities of WH/WD, moment, time from ED admission to 
      decision, and time from processing to withhold or withdrawal life-sustaining 
      treatment to death. Individuals who initiated (single emergency physician, 
      medical staff), and were involved in the decision (nursing staff, patients, and 
      families), and documentation of the decision in the medical record. RESULTS: 177 
      patients who died in ED between November 2009 and March 2010 were included. 
      Withholding and withdrawing life-sustaining treatment was applied to 30.5% of all 
      patients who died. Therapies were withheld in 24.2% and were withdrawn in 6.2%. 
      The most reasons for making these decisions were; absence of improvement 
      following a period of active treatment (61.1%), and expected irreversibility of 
      acute disorder in the first 24 h (42.6%). The most common modalities withheld or 
      withdrawn life-support therapy were mechanical ventilation (17%), vasopressor and 
      inotrops infusion (15.8%). Factors associated with WH/WD decisions were older age 
      (OR = 1.1; 95%IC = 1.01-1.07; P = 0.001), neurological acute medical disorders 
      (OR = 4.1; 95%IC = 1.48-11.68; P = 0.007), malignancy (OR = 7.7; 95%IC = 
      1.38-8.54; P = 0.002) and cardiovascular (OR = 3.4;95%IC = 2.06-28.5;P = 0.008) 
      chronic underlying diseases. CONCLUSION: Life-sustaining treatment were 
      frequently withheld or withdrawn from elderly patients with underlying chronic 
      cardiovascular disease or metastatic cancer or patients with acute neurological 
      medical disorders in a Moroccan ED. Religious beliefs and the lack of guidelines 
      and official Moroccan laws could explain the ethical limitations of the 
      decision-making process recorded in this study.
FAU - Damghi, Nada
AU  - Damghi N
AD  - Medical Emergency Department, Ibn Sina University Hospital, 10000, Rabat, 
      Morocco.
FAU - Belayachi, Jihane
AU  - Belayachi J
FAU - Aggoug, Badria
AU  - Aggoug B
FAU - Dendane, Tarek
AU  - Dendane T
FAU - Abidi, Khalid
AU  - Abidi K
FAU - Madani, Naoufel
AU  - Madani N
FAU - Zekraoui, Aicha
AU  - Zekraoui A
FAU - Belabes, Abdellatif Benchekroun
AU  - Belabes AB
FAU - Zeggwagh, Amine Ali
AU  - Zeggwagh AA
FAU - Abouqal, Redouane
AU  - Abouqal R
LA  - eng
PT  - Journal Article
DEP - 20110812
PL  - England
TA  - BMC Emerg Med
JT  - BMC emergency medicine
JID - 100968543
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Age Factors
MH  - Aged
MH  - Aged, 80 and over
MH  - Decision Making
MH  - Emergencies/*epidemiology
MH  - Emergency Service, Hospital/*statistics & numerical data
MH  - Female
MH  - Humans
MH  - Life Support Care/*statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Morocco/epidemiology
MH  - Retrospective Studies
MH  - Young Adult
PMC - PMC3199862
EDAT- 2011/08/16 06:00
MHDA- 2011/12/14 06:00
PMCR- 2011/08/12
CRDT- 2011/08/16 06:00
PHST- 2011/03/03 00:00 [received]
PHST- 2011/08/12 00:00 [accepted]
PHST- 2011/08/16 06:00 [entrez]
PHST- 2011/08/16 06:00 [pubmed]
PHST- 2011/12/14 06:00 [medline]
PHST- 2011/08/12 00:00 [pmc-release]
AID - 1471-227X-11-12 [pii]
AID - 10.1186/1471-227X-11-12 [doi]
PST - epublish
SO  - BMC Emerg Med. 2011 Aug 12;11:12. doi: 10.1186/1471-227X-11-12.