1
|
Reignier J, Feral-Pierssens AL, Boulain T, Carpentier F, Le Borgne P, Del Nista D, Potel G, Dray S, Hugenschmitt D, Laurent A, Ricard-Hibon A, Vanderlinden T, Chouihed T. Withholding and withdrawing life-support in adults in emergency care: joint position paper from the French Intensive Care Society and French Society of Emergency Medicine. Ann Intensive Care 2019; 9:105. [PMID: 31549266 PMCID: PMC6757069 DOI: 10.1186/s13613-019-0579-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/16/2019] [Indexed: 11/10/2022] Open
Abstract
For many patients, notably among elderly nursing home residents, no plans about end-of-life decisions and palliative care are made. Consequently, when these patients experience life-threatening events, decisions to withhold or withdraw life-support raise major challenges for emergency healthcare professionals. Emergency department premises are not designed for providing the psychological and technical components of end-of-life care. The continuous inflow of large numbers of patients leaves little time for detailed assessments, and emergency department staff often lack training in end-of-life issues. For prehospital medical teams (in France, the physician-staffed mobile emergency and intensive care units known as SMURs), implementing treatment withholding and withdrawal decisions that may have been made before the acute event is not the main focus. The challenge lies in circumventing the apparent contradiction between the need to make immediate decisions and the requirement to set up a complex treatment project that may lead to treatment withholding and/or withdrawal. Laws and recommendations are of little assistance for making treatment withholding and withdrawal decisions in the emergency setting. The French Intensive Care Society (Société de Réanimation de Langue Française, SRLF) and French Society of Emergency Medicine (Société Française de Médecine d'Urgence, SFMU) tasked a panel of emergency physicians and intensivists with developing a document to serve both as a position paper on life-support withholding and withdrawal in the emergency setting and as a guide for professionals providing emergency care. The task force based its work on the available legislation and recommendations and on a review of published studies.
Collapse
Affiliation(s)
- Jean Reignier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hotel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France. .,Université de Nantes, Nantes, France.
| | - Anne-Laure Feral-Pierssens
- Assistance Publique Hôpitaux de Paris, Service des Urgences, Hôpital Européen Georges Pompidou Paris, Paris, France
| | - Thierry Boulain
- Service de Réanimation Médicale Polyvalente, Centre Hospitalier Régional Orléans, Orléans, France
| | - Françoise Carpentier
- Pôle Urgences Médecine Aigüe, Hôpital Universitaire des Alpes, Grenoble, France.,Université de Grenoble, Grenoble, France
| | - Pierrick Le Borgne
- Service d'Accueil des Urgences, Hôpital de Hautepierre, CHRU Strasbourg, Strasbourg, France
| | | | - Gilles Potel
- Université de Nantes, Nantes, France.,Service des Urgences, CHU de Nantes, Nantes, France
| | - Sandrine Dray
- Service de Réanimation Médicale, Hôpital Nord, CHU de Marseille, Marseille, France
| | | | - Alexandra Laurent
- Laboratoire Psy-DREPI, Université de Bourgogne Franche-Comté, EA7458, Dijon, France
| | - Agnès Ricard-Hibon
- SAMU-SMUR 95- Service des Urgences, Centre Hospitalier René Dubos, Pontoise, France
| | - Thierry Vanderlinden
- Service de Réanimation Polyvalente, Groupe Hospitalier Institut Catholique de Lille/Faculté Libre de Médecine/Université Lille Nord de France, Lille, France
| | - Tahar Chouihed
- SAMU-SMUR-Service d'Urgences, Hôpital Central, CHRU Nancy, Vandoeuvre les Nancy, France.,INSERM U1116, Université de Lorraine, Vandoeuvre les Nancy, France
| | | |
Collapse
|
2
|
Feral-Pierssens AL, Boulain T, Carpentier F, Le Borgne P, Del Nista D, Potel G, Dray S, Hugenschmitt D, Laurent A, Ricard-Hibon A, Vanderlinden T, Chouihed T, Reignier J. Limitations et arrêts des traitements de suppléance vitale chez l’adulte dans le contexte de l’urgence. MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
3
|
Feral-Pierssens AL, Boulain T, Carpentier F, Le Borgne P, Del Nista D, Potel G, Dray S, Hugenschmitt D, Laurent A, Ricard-Hibon A, Vanderlinden T, Chouihed T, Reignier J. Limitations et arrêts des traitements de suppléance vitale chez l’adulte dans le contexte de l’urgence. ANNALES FRANCAISES DE MEDECINE D URGENCE 2018. [DOI: 10.3166/afmu-2018-0058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
4
|
Le Jan A, Dupin A, Garrigue B, Sapir D. [Refractory cardiac arrest patients in prehospital care, potential organ donors]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2016; 61:50-52. [PMID: 27596502 DOI: 10.1016/j.soin.2016.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Under the authority of the French Biomedicine Agency, a new care pathway integrates refractory cardiac arrest patients into a process of organ donation. It is a medical, logistical and ethical challenge for the staff of the mobile emergency services.
Collapse
Affiliation(s)
- Arnaud Le Jan
- Smur, Centre hospitalier Sud Francilien, 116, bd Jean-Jaurès, 91106 Corbeil-Essonnes, France.
| | - Aurélie Dupin
- Smur, Centre hospitalier Sud Francilien, 116, bd Jean-Jaurès, 91106 Corbeil-Essonnes, France
| | - Bruno Garrigue
- Smur, Centre hospitalier Sud Francilien, 116, bd Jean-Jaurès, 91106 Corbeil-Essonnes, France
| | - David Sapir
- Smur, Centre hospitalier Sud Francilien, 116, bd Jean-Jaurès, 91106 Corbeil-Essonnes, France
| |
Collapse
|
5
|
Ortega-Deballon I, Hornby L, Shemie SD. Protocols for uncontrolled donation after circulatory death: a systematic review of international guidelines, practices and transplant outcomes. Crit Care 2015; 19:268. [PMID: 26104293 PMCID: PMC4495857 DOI: 10.1186/s13054-015-0985-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 06/12/2015] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION A chronic shortage of organs remains the main factor limiting organ transplantation. Many countries have explored the option of uncontrolled donation after circulatory death (uDCD) in order to expand the donor pool. Little is known regarding the variability of practices and outcomes between existing protocols. This systematic review addresses this knowledge gap informing policy makers, researchers, and clinicians for future protocol implementation. METHODS We searched MEDLINE, EMBASE, and Google Scholar electronic databases from 2005 to March 2015 as well as the reference lists of selected studies, abstracts, unpublished reports, personal libraries, professional organization reports, and government agency statements on uDCD. We contacted leading authors and organizations to request their protocols and guidelines. Two reviewers extracted main variables. In studies reporting transplant outcomes, we added type, quantity, quality of organs procured, and complications reported. Internal validity and the quality of the studies reporting outcomes were assessed, as were the methodological rigour and transparency in which a guideline was developed. The review was included in the international prospective register of systematic reviews (Prospero, CRD42014015258). RESULTS Six guidelines and 18 outcome studies were analysed. The six guidelines are based on limited evidence and major differences exist between them at each step of the uDCD process. The outcome studies report good results for kidney, liver, and lung transplantation with high discard rates for livers. CONCLUSIONS Despite procedural, medical, economic, legal, and ethical challenges, the uDCD strategy is a viable option for increasing the organ donation pool. Variations in practice and heterogeneity of outcomes preclude a meta-analysis and prevented the linking of outcomes to specific uDCD protocols. Further standardization of protocols and outcomes is required, as is further research into the role of extracorporeal resuscitation and other novel therapies for treatment of some refractory cardiac arrest. It is essential to ensure the maintenance of trust in uDCD programs by health professionals and the public.
Collapse
Affiliation(s)
- Iván Ortega-Deballon
- Canadian National Transplant Research Program, Montréal, Canada.
- Research Institute McGill University Health Centre, Montréal, Canada.
- Centre de Prélèvement d'Organes and Laboratoire de Simulation, Hôpital du Sacré-Cœur, Montréal, Canada.
- Faculty of Medicine and Health Sciences, Alcalá de Henares, Madrid, Spain.
- Helicopter Emergency Medical Service (SUMMA 112), Madrid, Spain.
- Critical Care Division, Montreal Children's Hospital, Office C-806, 2300, Rue Tupper, Montreal, QC, H3H 1P3, Canada.
| | - Laura Hornby
- DePPaRT Study, Pediatric Critical Care, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.
- Deceased Donation, Canadian Blood Services, Ottawa, Canada.
| | - Sam D Shemie
- Deceased Donation, Canadian Blood Services, Ottawa, Canada.
- Division of Critical Care, Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada.
- McGill University, Montreal, Canada.
| |
Collapse
|
6
|
Champigneulle B, Fieux F, Cheisson G, Dondero F, Savier E, Riou B, Langeron O, Nicolas-Robin A. French survey of the first three-years of liver transplantation activity from uncontrolled donors deceased after cardiac death. Anaesth Crit Care Pain Med 2015; 34:35-9. [PMID: 25829313 DOI: 10.1016/j.accpm.2014.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 05/22/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the first three years of French activity related to liver transplantation from uncontrolled donation after cardiac death (uDCD). STUDY DESIGN Prospective and observational study in the three active centres authorized by the French Biomedicine Agency. PATIENTS AND METHODS All patients deceased between 2010 and 2012 after an uncontrolled cardiac arrest admitted to one of three centres (Pitié-Salpêtrière, Saint-Louis or Bicêtre hospitals, AP-HP, Paris, France) and potentially eligible for liver recovery were included. Abdominal normothermic oxygenated recirculation (ANOR) was used for graft preservation. RESULTS One hundred twenty-six potential uDCD donors were identified as eligible for liver recovery after hospital admission. The main causes of organ recovery failure were technical failure related to ANOR (29 patients, 23%), refusal of consent (39 patients, 31% of potential uDCD donors and 40% of asked relatives) and abnormal hepatic transaminases up to 200 UI.L(-1) during ANOR (24 patients, 19%). Finally, 11 livers were transplanted. Process efficiency was 9% [95% CI: 4-15%]. One-year recipient survival was 82%, [95% CI: 48-98%] and one-year graft survival was 64% [95% CI: 31-89%]. CONCLUSION Liver transplantation from uDCD donors is achievable in France, despite low process efficiency.
Collapse
Affiliation(s)
- B Champigneulle
- Department of Anesthesiology and Critical Care, groupe hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - F Fieux
- Department of Anesthesiology and Critical Care & Organ Transplant Coordination Team, hôpital Saint-Louis, AP-HP, Paris, France
| | - G Cheisson
- Department of Anesthesiology and Critical Care & Organ Transplant Coordination Team, hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - F Dondero
- Hepatobiliary Surgery and Liver Transplantation Department, hôpital Beaujon, AP-HP, Clichy, France
| | - E Savier
- Hepatobiliary Surgery and Liver Transplantation Department, groupe hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - B Riou
- Department of Emergency Medicine and Surgery, groupe hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; UMRS Inserm 956, université médecine Pierre-et-Marie-Curie-Paris 6, 4, place Jussieu, 75005 Paris, France
| | - O Langeron
- Department of Anesthesiology and Critical Care, groupe hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; UMRS Inserm 956, université médecine Pierre-et-Marie-Curie-Paris 6, 4, place Jussieu, 75005 Paris, France
| | - A Nicolas-Robin
- Department of Anesthesiology and Critical Care, groupe hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; UMRS Inserm 956, université médecine Pierre-et-Marie-Curie-Paris 6, 4, place Jussieu, 75005 Paris, France.
| |
Collapse
|
7
|
de Lora P. What does "presumed consent" might presume? Preservation measures and uncontrolled donation after circulatory determination of death. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2014; 17:403-411. [PMID: 24481849 DOI: 10.1007/s11019-014-9548-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
One of the most controversial aspects in uncontrolled (out-of-hospital) donation of organs after circulatory death (uDCD) is the initiation of preservation measures before death. I argue that in so-called opting-out systems only under very stringent conditions we might presume consent to the instauration of those measures. Given its current legal framework, I claim that this is not the case of Spain, a well-known country in which consent is presumed-albeit only formally-and where uDCD is currently practiced.
Collapse
Affiliation(s)
- Pablo de Lora
- Department of Legal Philosophy, Law School, Universidad Autónoma de Madrid, 28049, Madrid, Spain,
| |
Collapse
|
8
|
Fritz C, Durin L, Lalot JM, Meistelman C, Raft J. [Seventy-two hours prolonged brain death because of a foreign non-French resident status]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2013; 32:63-64. [PMID: 23273504 DOI: 10.1016/j.annfar.2012.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 10/09/2012] [Indexed: 06/01/2023]
|
9
|
Fieux F, Jacob L. Donneurs décédés après arrêt cardiaque: mise au point. MEDECINE INTENSIVE REANIMATION 2013. [DOI: 10.1007/s13546-012-0624-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|