Évaluation des démarches de limitation et d’arrêt de traitement en salle d’accueil des urgences vitales

Objectives. - To evaluate the practices of withholding and withdrawing of life sustaining therapies in a vital emergencies department and to confront them with Leonetti law procedures. Study design. - Prospective, observational study. Patient and methods. - Collection of data performed by a physician (senior or junior) for all patients for whom a decision of withholding or withdrawing life sustaining treatments was taken. Results. - Fifty-two patients were included. A withholding life sustaining treatments as non aggressive resuscitation procedures were instituted for 65% of the patients, of whom 85% were "waiting resuscitation". In 50% of the cases, the decision was taken by a single physician. The approval of the nursing staff was researched in 65% of the cases. The decision was written in the medical file in 94% of the cases. The patient's will was researched in 15% of the cases. The family was consulted about patient's will in 10% of the cases. The family was informed of the decision in 90% of the cases. Conclusion. - The application of Leonetti law in vital emergencies department is flawed. It appears to be necessary to realize new studies and to release official guidelines or recommendations specifically made for emergencies department to improve the practices of withholding or withdrawing life sustaining treatments. (C) 2011 Elsevier Masson SAS. All rights reserved.