Neuroanaesthesia & neurocritical care
Decisions to withdraw or withhold life-sustaining therapies in patients with and without acute brain injury: a secondary analysis of two prospective cohort studies
Authors' conclusion
Our findings suggest that WLST decisions are significantly more common in patients with ABI versus patients without ABI and occur earlier in this group.
Study context
- Population
- Invasively or non-invasively ventilated intensive care unit (ICU) patients, 40 countries, 2004–201616,791 in WLST analysis
- Participants
- 21,970 participants
- Comparison
- Patients with vs without acute brain injury
- ABIn = 2,191
- Non-ABIn = 14,600reference
- Primary endpoint
- Incidence and timing of WLST
Methodological detailsinternational, multilevel logistic regression
- International
- Multilevel logistic regression
Primary result
As reported in the abstract
WLST incidence
Each group vs Non-ABIRisk difference (95% CI)
ABI
5.5%(3.8–7.1)
Each group vs Non-ABIOdds ratio (95% CI)
ABI
2.42(1.89–3.12)
Further findings
Median, days
| Outcome | ABI | Non-ABI | Absolute difference (days) (95% CI) | |
|---|---|---|---|---|
| Time to WLST after ICU admission | 4 (IQR 2–9) | 6 (IQR 2–13) | 2 (1–3) | |
| −2024Difference, days (linear scale) |
| Outcome | ABI | Non-ABI |
|---|---|---|
| Between-ICU variability in WLST decisionsVariability high | ||
| Median OR | 3.04 (95% CI 2.54-3.67) | 2.59 (2.38-2.78) |
Subgroups (ABI subgroups, world regions, cohort years)
- Findings similar across ABI subgroups, world regions, and cohort years
Original publication
Decisions to withdraw or withhold life-sustaining therapies in patients with and without acute brain injury: a secondary analysis of two prospective cohort studies. Lancet Respir Med. Published 17 March 2025. doi:10.
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