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Standardized High-Quality Processes for End-of-Life-Decision Making in the Intensive Care Unit Remain Robust during an Unprecedented New Pandemic—A Single-Center Experience

Author

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  • Fanny Marsch

    (Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany)

  • Claudia D. Spies

    (Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany)

  • Roland C. E. Francis

    (Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
    Department of Anesthesiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany)

  • Jan A. Graw

    (Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
    Department of Anesthesiology and Intensive Care Medicine, Universitätsklinikum Ulm, Ulm University, 89081 Ulm, Germany)

Abstract

Due to the global COVID-19 pandemic, a concomitant increase in awareness for end-of-life decisions (EOLDs) and advance care planning has been noted. Whether the dynamic pandemic situation impacted EOLD-processes on the intensive care unit (ICU) and patient-sided advance care planning in Germany is unknown. This is a retrospective analysis of all deceased patients of surgical ICUs of a university medical center from March 2020 to July 2021. All included ICUs had established standardized protocols and documentation for EOLD-related aspects of ICU therapy. The frequency of EOLDs and advance directives and the process of EOLDs were analyzed (No. of ethical approval EA2/308/20). A total number of 319 (85.5%) of all deceased patients received an EOLD. Advance directives were possessed by 83 (22.3%) of the patients and a precautionary power of attorney by 92 (24.7%) of the patients. There was no difference in the frequency of EOLDs and patient-sided advance care planning between patients with COVID-19 and non-COVID-19 patients. In addition, no differences in frequencies of do-not-resuscitate orders, withholding or withdrawing of intensive care medicine therapeutic approaches, timing of EOLDs, and participation of senior ICU attendings in EOLDs were noted between patients with COVID-19 and non-COVID-19 patients. Documentation of family conferences occurred more often in deceased patients with COVID-19 compared to non-COVID-19 patients (COVID-19: 80.0% vs. non-COVID-19: 56.8, p = 0.001). Frequency of EOLDs and completion rates of advance directives remained unchanged during the pandemic compared to pre-pandemic years. The EOLD process did not differ between patients with COVID-19 and non-COVID-19 patients. Institutional standard procedures might contribute to support the robustness of EOLD-making processes during unprecedented medical emergencies, such as new pandemic diseases.

Suggested Citation

  • Fanny Marsch & Claudia D. Spies & Roland C. E. Francis & Jan A. Graw, 2022. "Standardized High-Quality Processes for End-of-Life-Decision Making in the Intensive Care Unit Remain Robust during an Unprecedented New Pandemic—A Single-Center Experience," IJERPH, MDPI, vol. 19(22), pages 1-9, November.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:22:p:15015-:d:972870
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    References listed on IDEAS

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    1. Berger, Elke & Winkelmann, Juliane & Eckhardt, Helene & Nimptsch, Ulrike & Panteli, Dimitra & Reichebner, Christoph & Rombey, Tanja & Busse, Reinhard, 2022. "A country-level analysis comparing hospital capacity and utilisation during the first COVID-19 wave across Europe," Health Policy, Elsevier, vol. 126(5), pages 373-381.
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