You wish, you never have to make such a decision!
"The decision to cease life support is never easy. Yet, family and loved ones are often asked to make it within 72 hours. That’s because, according to conventional wisdom, if a person with a serious brain injury doesn’t show notable signs of improvement in that timeframe, the likelihood they’ll recover is slim to none. But a new study looking at actual patients challenges that idea.
The researchers pulled data from nearly 1400 patients who were admitted into intensive care units for traumatic brain injuries. From this information, the team developed a mathematical model that could match cases where life support measures were withdrawn to ones where they weren’t, accounting for variables like age and nature of the injury. That resulted in 56 coma patient pairs, within which one of the couple had life-sustaining treatments ceased while the other continued to receive care. In the latter group, 45% survived for at least six months, and of those, more than 30% recovered at least partial independence. Four of the 56 patients that continued to receive care were considered “fully” recovered within a year."
From the abstract:
"Among patients with severe traumatic brain injury (TBI), there is high prognostic uncertainty but growing evidence that recovery of independence is possible. Nevertheless, families are often asked to make decisions about withdrawal of life-sustaining treatment (WLST) within days of injury. The range of potential outcomes for patients who died after WLST (WLST+) is unknown, posing a challenge for prognostic modeling and clinical counseling. We investigated the potential for survival and recovery of independence after acute TBI in patients who died after WLST. We used Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) data and propensity score matching to pair participants with WLST+ to those with a similar probability of WLST (based on demographic and clinical characteristics), but for whom life-sustaining treatment was not withdrawn (WLST−). To optimize matching, we divided the WLST− cohort into tiers (Tier 1 = 0-11%, Tier 2 = 11-27%, Tier 3 = 27-70% WLST propensity). We estimated the level of recovery that could be expected in WLST+ participants by evaluating 3-, 6-, and 12-month Glasgow Outcome Scale-Extended (GOSE) and Disability Rating Scale outcomes in matched WLST− participants. Of 90 WLST+ participants (80% male, mean [standard deviation; SD] age = 59.2 [17.9] years, median [IQR] days to WLST = 5.4 [2.2, 11.7]), 80 could be matched to WLST− participants. Of 56 WLST− participants who were followed at 6 months, 31 (55%) died. Among survivors in the overall sample and survivors in Tiers 1 and 2, more than 30% recovered at least partial independence (GOSE ≥4). In Tier 3, recovery to GOSE ≥4 occurred at 12 months, but not 6 months, post-injury. These results suggest a substantial proportion of patients with TBI and WLST may have survived and achieved at least partial independence. However, death or severe disability is a common outcome when the probability of WLST is high. While further validation is needed, our findings support a more cautious clinical approach to WLST and more complete reporting on WLST in TBI studies."
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