Modes of dying of children in Intensive Care Units in Spain: MOMUCIP study

• Published in: Anales de Pediatría 2019-10, Vol.91 (4), p.228-236
• Main Authors: María Carmen Agra Tuñas, Francisco Javier Pilar Orive, Elva Rodríguez Merino, Jesús López-Herce Cid, Gema Manrique Martín, Paula García Casas, Arturo Hernández González, Carmen Ramil Fraga, Corsino Rey Galán, María Rosario Riestra Rodríguez, Ramón Hernández Rastrollo, Francisco Fernández Carrión, Antonio Rodríguez Núñez
• Format: Article
• Language: Spanish
• Subjects: Adecuación del esfuerzo terapéutico; Cuidados intensivos; Limitación de tratamientos de soporte vital; Limitación del esfuerzo terapéutico; Muerte; Niños
• ISSN: 2341-2879; 2341-2879

Objective: To describe the different types of child deaths in Paediatric Intensive Care Units (PICU) in Spain, and to analyse the characteristics of those dying from a limitation of therapeutic effort (LET). Method: A multicentre retrospective study by conducted by reviewing the hospital discharge reports corresponding to deceased patients in 8 Spanish PICUs between 2011 and 2017. Results: A total of 337 deaths were recorded, of which 151 (50.7%) occurred after a decision of LET, while 114 (33.8%) were due to an indicated, but failed, cardiopulmonary resuscitation, and 52 (15.4%) were due to brain death. The most common causes of hospital admission for those children that finally died were a heart-related problem (32.6%) or a respiratory problem (22.6%).A total of 86 cases (25.5%) had a previous hospital admission, with 253 cases (75%) suffering from some type of chronical illness, and 78 (23%) had a serious disability at the time of the admission.LET cases were more frequent among these children and those suffering from cancer. The predominant LET type consisted in: not starting the CPR in the event of a cardiac arrest (45%), withdrawal of the respiratory support (31.6%), and withdrawal of vasoactive drugs (21.6%). Conclusions: At the present time, at least half of the children dying in a PICU in Spain die after a LET decision, which is more frequent in those patients with previous hospital admissions, with a serious incapacity, and chronic or oncological disease. Health professionals should be aware of this situation, and be prepared to share decisions with the families, and to offer children at the end of their life the best possible caring quality. Resumen: Objetivo: Describir los modos de muerte de los niños en las Unidades de Cuidados Intensivos Pediátricos (UCIP) en España y analizar las características de aquellos que fallecen tras decidir una limitación del esfuerzo terapéutico (LET). Métodos: Estudio retrospectivo multicéntrico mediante revisión de informes de alta de los pacientes fallecidos en 8 UCIPs españolas entre 2011 y 2017. Resultados: Se recogieron 337 fallecimientos, de los cuales 151 (50,7%) ocurrieron durante una decisión de LET, mientras que 114 (33,8%) fueron por reanimación cardiopulmonar indicada pero fallida (FRCP) y 52 (15,4%) por muerte cerebral. Los motivos más frecuentes de ingreso en los niños que luego fallecieron fueron cardíacos (32,6%) y respiratorios (22,6%). El 25,5% (86 casos) habían tenido ingresos previos, 253 (75.1