Delaying Life Support Withdrawal May Benefit Severe Brain Injury Patients, Study Finds

A recent study suggests delaying life support withdrawal decisions for severe traumatic brain injury patients, as some may recover independence months later. Researchers analyzed data from 1,392 patients and found 45% survived at least six months, with over 30% regaining some independence.

Nitish Verma
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Delaying Life Support Withdrawal May Benefit Severe Brain Injury Patients, Study Finds

Delaying Life Support Withdrawal May Benefit Severe Brain Injury Patients, Study Finds

A recent study published in the Journal of Neurotrauma on May 13, 2024, suggests that delaying decisions to withdraw life support for patients with severe traumatic brain injuries may be beneficial, as some patients can recover a degree of independence months after their injury. The findings challenge current clinical practices, which often involve making withdrawal decisions within 72 hours based on the assumption that patients are unlikely to survive or recover unless they show rapid improvement in the first few days.

Why this matters: This study's findings have significant implications for the medical community and families of severe brain injury patients, as it highlights the need for a more cautious approach to making life-or-death decisions. By delaying withdrawal of life support, healthcare providers may be able to give patients a better chance at recovery, which could lead to improved patient outcomes and reduced healthcare costs.

Researchers from Mass General Brigham in Boston analyzed data from 1,392 traumatic brain injury patients admitted to intensive care units at 18 U.S. trauma centers over a 7.5-year period. They found that 45% of patients who remained on life support survived for at least six months, and more than 30% of those survivors recovered enough to have at least some independence in daily activities. However, only four patients fully recovered to their pre-injury state.

To determine which patients were more likely to have life support withdrawn, the researchers created a mathematical model based on factors such as age, sex, health background, injury characteristics, and clinical features. They then matched 80 patients who died after life support withdrawal with 132 patients who had a similar health trajectory but continued receiving life-sustaining treatment. The study suggests that some patients in the withdrawal group may have survived and regained some independence if given more time.

"Our findings support a more cautious approach to making early decisions on withdrawal of life support," said Dr. Yelena Bodien, the study's senior author and a neurologist at Massachusetts General Hospital. "Traumatic brain injury is a chronic condition that requires long-term follow-ups to understand patient outcomes. Delaying decisions regarding life support may be warranted to better identify patients whose condition may improve."

Several experts praised the study for highlighting the need to give severe brain injury patients more time before making irreversible decisions. "This study emphasizes the importance of not giving up on patients too quickly," said Dr. Ariane Lewis, a professor at NYU Langone Medical Center. Dr. Julio Chalela from the Medical University of South Carolina advised doctors to be cautious about withdrawing life support, particularly in the first 72 hours after injury.

However, Dr. Erol Veznedaroglu from Drexel University College of Medicine expressed concerns that the study may give families false hope and complicate decision-making for patients with little chance of meaningful recovery. The researchers acknowledged limitations, such as the inability to estimate potential outcomes for the oldest and most severely injured patients due to a lack of comparable cases where life support was continued.

Severe traumatic brain injury affects over 5 million people worldwide each year, making it a leading cause of death and disability. Predicting outcomes is challenging, and families are often asked to make difficult decisions about continuing or withdrawing life support within days of the injury. Currently, there are no precise guidelines to determine which patients are most likely to recover. The study's authors recommend further research with larger sample sizes to better understand the variable recovery trajectories of severe brain injury patients and inform decision-making in these critical cases.

Key Takeaways

  • Delaying life support withdrawal for severe brain injury patients may improve recovery chances.
  • 45% of patients on life support survived for at least 6 months, with 30% regaining some independence.
  • Current clinical practices often involve making withdrawal decisions within 72 hours, which may be too soon.
  • A more cautious approach to making life-or-death decisions is recommended to give patients a better chance at recovery.
  • Further research is needed to better understand recovery trajectories and inform decision-making in critical cases.