BOSTON — The decision to take a loved one off life support is one of the most gut-wrenching and traumatizing choices someone can make. While doctors often give families a grim prognosis when their relative is hospitalized with a severe traumatic brain injury, a new study is providing a shocking ray of hope. Researchers at Mass General Brigham have a simple message: don’t rush to make a decision when it comes to ending life-sustaining treatment. Their findings show that families are often asked to make a life-or-death decision signs of a recovery are able to emerge.
Specifically, the new study explains that families are often asked to decide if doctors should withdraw life support measures, including removing mechanical breathing tubes, within 72 hours of a family member’s injury. To put it bluntly, from the time someone’s loved one suffers a severe brain injury, hospitals typically give their next of kin just three days to decide if there’s any hope they’ll recover. The Mass General Brigham team finds that’s simply not enough time, and people could be pressured into “pulling the plug” on relatives who would actually live!
“Our findings support a more cautious approach to making early decisions on withdrawal of life support,” says corresponding author Yelena Bodien, PhD, of the Department of Neurology’s Center for Neurotechnology and Neurorecovery at Massachusetts General Hospital and of the Spaulding-Harvard Traumatic Brain Injury Model Systems, in a media release.
“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.”
To reach this disturbing finding, published in the Journal of Neurotrauma, the Boston-based team examined the clinical outcomes of TBI patients enrolled in the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study, including those who had life support withdrawn. Specifically, that data included 1,392 TBI patients in intensive care units at 18 U.S. trauma centers over a 7.5-year period.
From there, the team created a mathematical model which calculated the likelihood that a family would choose to withdraw life support from a TBI patient based on the information coming from doctors. This decision also included the family’s demographics and socioeconomic factors. Then, researchers compared this calculation to a group of patients who did not have life support withdrawn and were given a longer chance to recover.
The comparison came to an unsettling conclusion. After comparing the injuries among patients taken off of life support to those who remained on life support, some patients may have survived and recovered some level of independence a few months after injury if they had been given more time. In fact, the team found over 40 percent of the patients remaining on life support recovered from their injuries to some degree. Simply put, leaving a loved one on life support gave them a nearly 50-50 shot of surviving.
Dr. Bodien’s team says that doctors and families are often a part of a “self-fulfilling prophecy” in these cases. They explain that doctors giving families poor neurologic prognoses is the main reason many people believe they’re “ending a loved one’s suffering” by choosing to pull life support. However, doctors often assume their patients with severe TBI will not recover because of the data on previous brain trauma cases.
Essentially, doctors have a wealth of data saying that TBI patients likely won’t survive. This may color their opinion of the current case and the recommendations they give to families. After receiving such a grim forecast, families are influenced into giving up hope their loved one will recover. However, the new study finds the odds may be a lot better than most people think, and it’s worth waiting for a sign of hope.
