A Sandiumenge

B Cancio

E Navas

E Oliver

G Miró

G Moreno

J Twose

M Badia

M Bodi

M Ibañez

M Jurado

M Llauradó

M Lopez

MD Bosque Cebolla

N Masnou

T Pont

Intensive Care Medicine Experimental

PubMed

Crossref

POSTER PRESENTATION Open AccessImpact of an on-line educational program on lifesupport treatment limitation (LSTL) andpotentiality for donation after controlled cardiacdeath (CDCD) of critically ill patients in 11hospitals of cataloniaA Sandiumenge1*, G Moreno2, M Llauradó3, N Masnou4, E Oliver5, M Ibañez6, M Lopez7, B Cancio8, E Navas9,G Miró10, M Jurado11, M Badia12, MD Bosque Cebolla13, J Twose14, T Pont1, M Bodi15From ESICM LIVES 2015Berlin, Germany. 3-7 October 2015IntroductionThe lack of education on LSTL and cDCD of intensivecare unit (ICU) health-care professionals may lead tomisperceptions and contributes to negative attitudeshampering the development of such programs (1).ObjectivesWe aimed to assess the impact of LSTL and cDCDtraining on the End-of-life care practices and potential-ity for cDCD of 11 catalonian ICUs.MethodsData on End-of-Life Care of critically ill patientsadmitted to 11 catalonian ICUs was prospectively col-lected before (P1: 01/3-31/06 2013) and after (P2: 01/2-30/05) an on-line training educational program on LSTLand cDCD delivered to 58 nurses and 62 doctors of theparticipating centres. Potential for cDCD was assessedthrough the analysis of clinical, analytical and agonaltimes (time from LSTL initiation to asystole) of patientsin whom withdrawal of mechanical ventilation (MV)and/or vasoactive support (VAS) was performed as aform of LTSL.ResultsA total of 6616 patients (P1:3315; P2:3301) were admittedwith similar rates (P1:9.8%; P2:9.6%) and characteristicsof patients undergoing LSTL in both periods. No differ-ences were observed on the time from admission to First(5,19 ± 9.0 vs 4.33 ± 8.94 days) and Definitive-LSTL (D-LSTL-the one preceding patient´s death) (P1:n=215; 6.83± 11.6 vs P2:n=205; 6.97 ± 11.0 days) actions betweenperiods. Futility (P1:74%; P2:73%), admission diagnosis(P1:62%; P2:50%) and co-morbidity (P1:40%; P2 45.9%)were the main causes for D-LSTL in both periods. Treat-ment withdrawal was the most common form of D-LSTL(P1:57.7%; P2:51.2%) with higher rates of ventilator sup-port withdrawal during P2 (80% vs 67%)p < 0.05. Seda-tion and/or analgesia was provided in 81%(P1) and 82.6%(P2) of patients in whom treatment was withdrawn. Ago-nal times after treatment withdrawal were shorter in P2(n = 105)(115.0 min (25-75ICR 37.0-405.0) compared toP1(n=124)(197.5 (25-75ICR 55.0-675.0)(p < 0.05). Six(7.7%) and 4(5.5%) patients in whom VAS and MV waswithdrawn during P1 and P2 could have been cDCDdonors representing a 24% and 25% increase over theDBD donor pool respectively.ConclusionsAlthough not influencing the potentiality of cDCD,training on LSTL improved end-of-life practices on criti-cally ill patients.Grant AcknowledgmentFundación Mutua Madrileña 2013.1University Hospital Vall d´Hebron, Barcelona, SpainFull list of author information is available at the end of the articleSandiumenge et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A652http://www.icm-experimental.com/content/3/S1/A652© 2015 Sandiumenge et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, providedthe original work is properly cited.Authors’ details1University Hospital Vall d´Hebron, Barcelona, Spain. 2University Hospital JoanXXIII, Tarragona, Spain. 3University Rovira i Virgili, Tarragona, Spain.4University Hospital Josep Trueta, Girona, Spain. 5University Hospital Bellvitge,Barcelona, Spain. 6University Hospital Virgen de la Cinta, Tortosa, Spain.7Hospital de Vic, Vic, Spain. 8University Hospital Moises Broggi, Barcelona,Spain. 9University Hospital Mutua de Tarrasa, Tarrasa, Spain. 10Hospital deMataró, Mataró, Spain. 11Hospital de Tarrasa, Tarrasa, Spain. 12UniversityHospital Arnau de Vilanova, Lleida, Spain. 13Hospital General de Cataluña,Barcelona, Spain. 14OCATT, Barcelona, Spain. 15University Hospital Joan XIII,Tarragona, Spain.Published: 1 October 2015Reference1. D’Alessandro AM, Peltier JW, Phelps JE: Understanding the antecedents ofthe acceptance of donation after cardiac death by healthcareprofessionals. Crit Care Med 2008, 36:1075-81.doi:10.1186/2197-425X-3-S1-A652Cite this article as: Sandiumenge et al.: Impact of an on-line educationalprogram on life support treatment limitation (LSTL) and potentiality fordonation after controlled cardiac death (CDCD) of critically ill patientsin 11 hospitals of catalonia. Intensive Care Medicine Experimental 20153(Suppl 1):A652.Submit your manuscript to a journal and benefi t from:7 Convenient online submission7 Rigorous peer review7 Immediate publication on acceptance7 Open access: articles freely available online7 High visibility within the fi eld7 Retaining the copyright to your article    Submit your next manuscript at 7 springeropen.comSandiumenge et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A652http://www.icm-experimental.com/content/3/S1/A652Page 2 of 2

Impact of an on-line educational program on life support treatment limitation (lstl) and potentiality for donation after controlled cardiac death (cdcd) of critically ill patients in 11 hospitals of catalonia

Springer - Publisher Connector

POSTER PRESENTATION Open Access
Impact of an on-line educational program on life
support treatment limitation (LSTL) and
potentiality for donation after controlled cardiac
death (CDCD) of critically ill patients in 11
hospitals of catalonia
A Sandiumenge1*, G Moreno2, M Llauradó3, N Masnou4, E Oliver5, M Ibañez6, M Lopez7, B Cancio8, E Navas9,
G Miró10, M Jurado11, M Badia12, MD Bosque Cebolla13, J Twose14, T Pont1, M Bodi15
From ESICM LIVES 2015
Berlin, Germany. 3-7 October 2015
Introduction
The lack of education on LSTL and cDCD of intensive
care unit (ICU) health-care professionals may lead to
misperceptions and contributes to negative attitudes
hampering the development of such programs (1).
Objectives
We aimed to assess the impact of LSTL and cDCD
training on the End-of-life care practices and potential-
ity for cDCD of 11 catalonian ICUs.
Methods
Data on End-of-Life Care of critically ill patients
admitted to 11 catalonian ICUs was prospectively col-
lected before (P1: 01/3-31/06 2013) and after (P2: 01/2-
30/05) an on-line training educational program on LSTL
and cDCD delivered to 58 nurses and 62 doctors of the
participating centres. Potential for cDCD was assessed
through the analysis of clinical, analytical and agonal
times (time from LSTL initiation to asystole) of patients
in whom withdrawal of mechanical ventilation (MV)
and/or vasoactive support (VAS) was performed as a
form of LTSL.
Results
A total of 6616 patients (P1:3315; P2:3301) were admitted
with similar rates (P1:9.8%; P2:9.6%) and characteristics
of patients undergoing LSTL in both periods. No differ-
ences were observed on the time from admission to First
(5,19 ± 9.0 vs 4.33 ± 8.94 days) and Definitive-LSTL (D-
LSTL-the one preceding patient´s death) (P1:n=215; 6.83
± 11.6 vs P2:n=205; 6.97 ± 11.0 days) actions between
periods. Futility (P1:74%; P2:73%), admission diagnosis
(P1:62%; P2:50%) and co-morbidity (P1:40%; P2 45.9%)
were the main causes for D-LSTL in both periods. Treat-
ment withdrawal was the most common form of D-LSTL
(P1:57.7%; P2:51.2%) with higher rates of ventilator sup-
port withdrawal during P2 (80% vs 67%)p < 0.05. Seda-
tion and/or analgesia was provided in 81%(P1) and 82.6%
(P2) of patients in whom treatment was withdrawn. Ago-
nal times after treatment withdrawal were shorter in P2
(n = 105)(115.0 min (25-75ICR 37.0-405.0) compared to
P1(n=124)(197.5 (25-75ICR 55.0-675.0)(p < 0.05). Six
(7.7%) and 4(5.5%) patients in whom VAS and MV was
withdrawn during P1 and P2 could have been cDCD
donors representing a 24% and 25% increase over the
DBD donor pool respectively.
Conclusions
Although not influencing the potentiality of cDCD,
training on LSTL improved end-of-life practices on criti-
cally ill patients.
Grant Acknowledgment
Fundación Mutua Madrileña 2013.
1University Hospital Vall d´Hebron, Barcelona, Spain
Full list of author information is available at the end of the article
Sandiumenge et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A652
http://www.icm-experimental.com/content/3/S1/A652
© 2015 Sandiumenge et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided
the original work is properly cited.
Authors’ details
1University Hospital Vall d´Hebron, Barcelona, Spain. 2University Hospital Joan
XXIII, Tarragona, Spain. 3University Rovira i Virgili, Tarragona, Spain.
4University Hospital Josep Trueta, Girona, Spain. 5University Hospital Bellvitge,
Barcelona, Spain. 6University Hospital Virgen de la Cinta, Tortosa, Spain.
7Hospital de Vic, Vic, Spain. 8University Hospital Moises Broggi, Barcelona,
Spain. 9University Hospital Mutua de Tarrasa, Tarrasa, Spain. 10Hospital de
Mataró, Mataró, Spain. 11Hospital de Tarrasa, Tarrasa, Spain. 12University
Hospital Arnau de Vilanova, Lleida, Spain. 13Hospital General de Cataluña,
Barcelona, Spain. 14OCATT, Barcelona, Spain. 15University Hospital Joan XIII,
Tarragona, Spain.
Published: 1 October 2015
Reference
1. D’Alessandro AM, Peltier JW, Phelps JE: Understanding the antecedents of
the acceptance of donation after cardiac death by healthcare
professionals. Crit Care Med 2008, 36:1075-81.
doi:10.1186/2197-425X-3-S1-A652
Cite this article as: Sandiumenge et al.: Impact of an on-line educational
program on life support treatment limitation (LSTL) and potentiality for
donation after controlled cardiac death (CDCD) of critically ill patients
in 11 hospitals of catalonia. Intensive Care Medicine Experimental 2015
3(Suppl 1):A652.
Submit your manuscript to a 
journal and benefi t from:
7 Convenient online submission
7 Rigorous peer review
7 Immediate publication on acceptance
7 Open access: articles freely available online
7 High visibility within the fi eld
7 Retaining the copyright to your article
    Submit your next manuscript at 7 springeropen.com
Sandiumenge et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A652
http://www.icm-experimental.com/content/3/S1/A652
Page 2 of 2


IMPACT OF AN ON-LINE EDUCATIONAL PROGRAM ON LIFE SUPPORT TREATMENT LIMITATION (LSTL) AND POTENTIALITY FOR DONATION AFTER CONTROLLED CARDIAC DEATH (CDCD) OF CRITICALLY ILL PATIENTS IN 11 HOSPITALS OF CATALONIA

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Impact of an on-line educational program on life support treatment limitation (lstl) and potentiality for donation after controlled cardiac death (cdcd) of critically ill patients in 11 hospitals of catalonia

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