Death and Withholding of Life-Sustaining Therapy in the Emergency Department: A Retrospective Practical Study in a French Hospital during Four Years

Aim: We have analysed the medico-administrative features and the medical management of the patients who were died in the emergency department (ED) of a French hospital. Procedure: This retrospective observational study of all deceased patients in the emergency department took place from January 2012 to December 2015. We analysed the withholding of life-support therapy procedures and compared the groups "Withheld" and "Non-withheld". Results: Two hundred and thirty-two patients were died in the ED in four years. 20% of the death happened very quickly despite the intensive care and 80% happened after a medical decision of withholding or withdrawing life-sustaining therapies. The emergency physician chose to withhold the therapies alone in 56% of cases and the reflection period was very short: 13% before the arrival in the ED and 28% during the first hour. 14% of the decisions were not written in the medical chart. The patient of the Withheld group were older, suffered more frequently from dementia, came from a nursing home and displayed more serious symptoms (P < 0.01). They received comfort care in a short-stay ward: painkillers, hypnotic and cholinergic drugs when needed. Conclusion: Two-thirds of the withholding and withdrawal decisions did not respect the good practice requirements in terms of collegiality and traceability. An improvement of our practicing is possible through the development of a new frame for the decisions of withholding and withdrawing of life-support treatments which should take into account the pressure in emergency circumstances.