• Nicolas Côte, Alexis F Turgeon, François Lauzier, Lynne Moore, Damon C Scales, Francis Bernard, Ryan Zarychanski, Karen E A Burns, Maureen O Meade, David Zygun, Jean-François Simard, Amélie Boutin, Jacques G Brochu, and Dean A Fergusson.
• Division of Critical Care Medicine, Department of Anesthesiology, Université Laval, Quebec, QC, Canada.
• Neurocrit Care. 2013 Feb 1;18(1):154-60.

PurposeTo identify factors associated with decisions to withdraw life-sustaining therapies in patients with severe traumatic brain injury (TBI).Materials And MethodsWe conducted a 2-year multicenter retrospective cohort study (2005-2006) in mechanically ventilated patients aged 16 years and older admitted to the intensive care units (ICUs) of six Canadian level I trauma centers following severe TBI. One hundred and twenty charts were randomly selected at each center (n = 720). Data on ICU management strategies, patients' clinical condition, surgical procedures, diagnostic imaging, and decision to withdraw life-sustaining therapies were collected. The association of factors pertaining to the injury, interventions, and management strategies with decisions to withdraw life-sustaining therapies was evaluated among non-survivors.ResultsAmong the 228 non-survivors, 160 died following withdrawal of life-sustaining therapies. Patients were predominantly male (69.7 %) with a mean age of 50.7 (±21.7) years old. Brain herniation was more often reported in patients who died following decisions to withdraw life-sustaining therapies (odds ratio [OR] 2.91, 95 % confidence interval [CI] 1.16-7.30, p = 0.02) compared to those who died due to other causes (e.g., cardiac arrest, shock, etc.). Epidural hematomas (OR 0.18, 95 % CI 0.06-0.56, p < 0.01), craniotomies (OR 0.12, 95 % CI 0.02-0.68, p = 0.02), and other non-neurosurgical procedures (OR 0.08, 95 % CI 0.02-0.43, p < 0.01) were less often associated with death following withdrawal of life-sustaining therapies than death from other causes.ConclusionsDeath following decisions to withdraw life-sustaining therapies is associated with specific patient and clinical factors, and the intensity of care.

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