CE-SRLF recommendations concerning the decision making process in limiting or discontinuing life support in adults in postanoxic coma after cardiac arrest

Abstract

Since early evaluation of middle to long-term prognosis of patients remaining in coma after resuscitation following cardiac arrest has become a major concern for critical care physicians in terms of patient care as well as for ethical reasons, it appears necessary for the ethics committee (EC) of the Société de réanimation de langue française (SRLF) to issue recommendations regarding the decision making process to be respected in all deliberations for limitation or discontinuation of life support in patients; the aim is to avoid decisions based only on decision making algorithms such as those recommended by the American Society of Neurology. Additionally, since clinicians must document prognoses of patients remaining in coma after cardiac arrest, the CE-SRLF considers important to underline that there is always some worry and uncertainty in predicting patient’s outcome and that decision to limit or discontinue life support is difficult and cannot merely be based on a recommended flowchart. Due to these concerns, the CE-SRLF recognizes several clearly identified prognostic signs, each associated with a poor neurological outcome in patients remaining comatose after cardiac arrest. Nevertheless, an approach based on the detection of several among these signs should be a priority in order to help clinicians getting an opinion on the most likely outcome of a patient remaining comatose after cardiac arrest, allowing them to inform patient’s family members and friends with sincerity. It should be emphasized that each of such decisions is unique and should always result from a decision-making process among peers and conform to the current SRLF recommendations (2009) on limitation and discontinuation of life support in adult patients in the critical care unit.