Withholding and withdrawal of life-sustaining treatments in low-middle-income versus high-income Asian countries and regions

Phua J 1 , Joynt GM 2 , Nishimura M 3 , Deng Y 4 , Myatra SN 5 , Chan YH 6 Show all authors , Binh NG 7 , Tan CC 8 , Faruq MO 9 , Arabi YM 10 , Wahjuprajitno B 11 , Liu SF 12 , Hashemian SM 13 , Kashif W 14 , Staworn D 15 , Palo JE 16 , Koh Y 17 , ACME Study Investigators , Asian Critical Care Clinical Trials Group

Affiliations 

  • 1 Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Hospital, National University Health System, Singapore, Singapore
  • 2 Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
  • 3 Emergency and Critical Care Medicine, University of Tokushima Graduate School, Tokushima, Japan
  • 4 Intensive Care Unit, West China Hospital of Sichuan University, Chengdu, China
  • 5 Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Mumbai, India
  • 6 Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
  • 7 Intensive Care Department, Bach Mai Hospital, Hanoi, Vietnam
  • 8 Department of Anaesthesia and Intensive Care, Sultanah Aminah Hospital, Johor Bahru, Malaysia
  • 9 Department of Critical Care Medicine, BIRDEM General Hospital, Ibrahim Medical College, Dhaka, Bangladesh
  • 10 King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
  • 11 Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
  • 12 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
  • 13 Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • 14 Section of Nephrology, Pulmonary and Critical Care, Department of Medicine, Aga Khan University and Hospital, Karachi, Pakistan
  • 15 Phramongkutklao Hospital, Bangkok, Thailand
  • 16 The Medical City, Pasig City, Philippines
  • 17 Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap Dong Songpa Ku, Seoul, 138-736, South Korea. yskoh@amc.seoul.kr
Intensive Care Med, 2016 Jul;42(7):1118-27.
PMID: 27071388 DOI: 10.1007/s00134-016-4347-y

Abstract

PURPOSE: To compare the attitudes of physicians towards withholding and withdrawing life-sustaining treatments in intensive care units (ICUs) in low-middle-income Asian countries and regions with those in high-income ones, and to explore differences in the role of families and surrogates, legal risks, and financial considerations between these countries and regions.

METHODS: Questionnaire study conducted in May-December 2012 on 847 physicians from 255 ICUs in 10 low-middle-income countries and regions according to the World Bank's classification, and 618 physicians from 211 ICUs in six high-income countries and regions.

RESULTS: After we accounted for personal, ICU, and hospital characteristics on multivariable analyses using generalised linear mixed models, physicians from low-middle-income countries and regions were less likely to limit cardiopulmonary resuscitation, mechanical ventilation, vasopressors and inotropes, tracheostomy and haemodialysis than those from high-income countries and regions. They were more likely to involve families in end-of-life care discussions and to perceive legal risks with limitation of life-sustaining treatments and do-not-resuscitate orders. Nonetheless, they were also more likely to accede to families' requests to withdraw life-sustaining treatments in a patient with an otherwise reasonable chance of survival on financial grounds in a case scenario (adjusted odds ratio 5.05, 95 % confidence interval 2.69-9.51, P 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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