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Intensive Care Med. 2011 Nov;37(11):1881-7. doi: 10.1007/s00134-011-2357-3. Epub 2011 Oct 1.

Forgoing life support: how the decision is made in European pediatric intensive care units.

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Réanimation Pédiatrique, Assistance Publique-Hôpitaux de Paris, Département de recherche en éthique, Université Paris Sud 11, Hôpital de Bicêtre, 78 rue du Général Leclerc, 94275, Bicêtre, France.



To determine how decisions to forgo life support are made in European pediatric intensive care units (PICUs).


A multicenter, prospective study, the Eurydice II study, among 45 PICUs: 20 in France, 21 in Northern/Western (N/W) European countries, and 4 in Eastern/Central (E/C) Europe. Data were collected between November 2009 and April 2010 through a questionnaire.


The decision to forgo life-sustaining treatment was made in 166 (40.6%) out of 409 deceased children (median 42.9%, France 38.2%, N/W European countries 60.0%, E/C European countries 0%; P < 0.001). In the E/C group, more patients died after cardiopulmonary resuscitation (CPR) failure than after forgoing life support (P < 0.001). In all PICUs, caregivers discussed the decision during a formal meeting, after which the medical staff made the final decision. The decision was often documented in the medical record (median 100%). The majority of the parents were informed of the final decision and were at the bedside during their child's death (median 100%). Decision to forgo life-sustaining treatment occurred in 40.6% of children, compared with 33% in Eurydice I. A high percentage of parents from France were now informed about the meeting and its conclusion as compared with Eurydice I (median 100%).


The results of this study and comparison with the Eurydice I study (2002) show a trend towards standardization of end-of-life practices across N/W European countries and France in the past decade.

[Indexed for MEDLINE]

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