Cargando…
Medications and dosages used in medical assistance in dying: a cross-sectional study
BACKGROUND: There is little evidence describing the technical aspects of medical assistance in dying (MAiD) in Canada, such as medications, dosages and complications. Our objective was to describe clinical practice in providing MAiD in Ontario and Vancouver, Canada, and explore relations between med...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
CMA Impact Inc.
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8920593/ https://www.ncbi.nlm.nih.gov/pubmed/35042691 http://dx.doi.org/10.9778/cmajo.20200268 |
_version_ | 1784669159491108864 |
---|---|
author | Stukalin, Igor Olaiya, Oluwatobi R. Naik, Viren Wiebe, Ellen Kekewich, Mike Kelly, Michaela Wilding, Laura Halko, Roxanne Oczkowski, Simon |
author_facet | Stukalin, Igor Olaiya, Oluwatobi R. Naik, Viren Wiebe, Ellen Kekewich, Mike Kelly, Michaela Wilding, Laura Halko, Roxanne Oczkowski, Simon |
author_sort | Stukalin, Igor |
collection | PubMed |
description | BACKGROUND: There is little evidence describing the technical aspects of medical assistance in dying (MAiD) in Canada, such as medications, dosages and complications. Our objective was to describe clinical practice in providing MAiD in Ontario and Vancouver, Canada, and explore relations between medications used, time until death and complications. METHODS: We conducted a retrospective cohort study of a sample of adult (age ≥ 18 yr) patients who received MAiD in Ontario between 2016 and 2018, and patients who received MAiD in 1 of 3 Canadian academic hospitals (in Hamilton and Ottawa, Ontario, and Vancouver, British Colombia) between 2019 and 2020. We used de-identified data for 2016–2018 from the Office of the Chief Coroner for Ontario MAiD Database and chart review data for 2019–2020 from the 3 centres. We used multivariable parametric survival analysis to identify relations between medications, dosages and time from procedure start until death. RESULTS: The sample included 3557 patients (1786 men [50.2%] and 1770 women [49.8%] with a mean age of 74 [standard deviation 13] yr). The majority of patients (2519 [70.8%]) had a diagnosis of cancer. The medications most often used were propofol (3504 cases [98.5%]), midazolam (3251 [91.4%]) and rocuronium (3228 [90.8%]). The median time from the first injection until death was 9 (interquartile range 6) minutes. Standard-dose lidocaine (40–60 mg) and high-dose propofol (> 1000 mg) were associated with prolonged time until death (prolonged by a median of 1 min and 3 min, respectively). Complications occurred in 41 cases (1.2%), mostly related to venous access or need for administration of a second medication. INTERPRETATION: In a large sample of patients who died with medical assistance, certain medications were associated with small differences in time from injection to death, and complications were rare. More research is needed to identify the medication protocols that predict outcomes consistent with patient and family expectations for a medically assisted death. |
format | Online Article Text |
id | pubmed-8920593 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | CMA Impact Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-89205932022-03-18 Medications and dosages used in medical assistance in dying: a cross-sectional study Stukalin, Igor Olaiya, Oluwatobi R. Naik, Viren Wiebe, Ellen Kekewich, Mike Kelly, Michaela Wilding, Laura Halko, Roxanne Oczkowski, Simon CMAJ Open Research BACKGROUND: There is little evidence describing the technical aspects of medical assistance in dying (MAiD) in Canada, such as medications, dosages and complications. Our objective was to describe clinical practice in providing MAiD in Ontario and Vancouver, Canada, and explore relations between medications used, time until death and complications. METHODS: We conducted a retrospective cohort study of a sample of adult (age ≥ 18 yr) patients who received MAiD in Ontario between 2016 and 2018, and patients who received MAiD in 1 of 3 Canadian academic hospitals (in Hamilton and Ottawa, Ontario, and Vancouver, British Colombia) between 2019 and 2020. We used de-identified data for 2016–2018 from the Office of the Chief Coroner for Ontario MAiD Database and chart review data for 2019–2020 from the 3 centres. We used multivariable parametric survival analysis to identify relations between medications, dosages and time from procedure start until death. RESULTS: The sample included 3557 patients (1786 men [50.2%] and 1770 women [49.8%] with a mean age of 74 [standard deviation 13] yr). The majority of patients (2519 [70.8%]) had a diagnosis of cancer. The medications most often used were propofol (3504 cases [98.5%]), midazolam (3251 [91.4%]) and rocuronium (3228 [90.8%]). The median time from the first injection until death was 9 (interquartile range 6) minutes. Standard-dose lidocaine (40–60 mg) and high-dose propofol (> 1000 mg) were associated with prolonged time until death (prolonged by a median of 1 min and 3 min, respectively). Complications occurred in 41 cases (1.2%), mostly related to venous access or need for administration of a second medication. INTERPRETATION: In a large sample of patients who died with medical assistance, certain medications were associated with small differences in time from injection to death, and complications were rare. More research is needed to identify the medication protocols that predict outcomes consistent with patient and family expectations for a medically assisted death. CMA Impact Inc. 2022-01-18 /pmc/articles/PMC8920593/ /pubmed/35042691 http://dx.doi.org/10.9778/cmajo.20200268 Text en © 2022 CMA Impact Inc. or its licensors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/. |
spellingShingle | Research Stukalin, Igor Olaiya, Oluwatobi R. Naik, Viren Wiebe, Ellen Kekewich, Mike Kelly, Michaela Wilding, Laura Halko, Roxanne Oczkowski, Simon Medications and dosages used in medical assistance in dying: a cross-sectional study |
title | Medications and dosages used in medical assistance in dying: a cross-sectional study |
title_full | Medications and dosages used in medical assistance in dying: a cross-sectional study |
title_fullStr | Medications and dosages used in medical assistance in dying: a cross-sectional study |
title_full_unstemmed | Medications and dosages used in medical assistance in dying: a cross-sectional study |
title_short | Medications and dosages used in medical assistance in dying: a cross-sectional study |
title_sort | medications and dosages used in medical assistance in dying: a cross-sectional study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8920593/ https://www.ncbi.nlm.nih.gov/pubmed/35042691 http://dx.doi.org/10.9778/cmajo.20200268 |
work_keys_str_mv | AT stukalinigor medicationsanddosagesusedinmedicalassistanceindyingacrosssectionalstudy AT olaiyaoluwatobir medicationsanddosagesusedinmedicalassistanceindyingacrosssectionalstudy AT naikviren medicationsanddosagesusedinmedicalassistanceindyingacrosssectionalstudy AT wiebeellen medicationsanddosagesusedinmedicalassistanceindyingacrosssectionalstudy AT kekewichmike medicationsanddosagesusedinmedicalassistanceindyingacrosssectionalstudy AT kellymichaela medicationsanddosagesusedinmedicalassistanceindyingacrosssectionalstudy AT wildinglaura medicationsanddosagesusedinmedicalassistanceindyingacrosssectionalstudy AT halkoroxanne medicationsanddosagesusedinmedicalassistanceindyingacrosssectionalstudy AT oczkowskisimon medicationsanddosagesusedinmedicalassistanceindyingacrosssectionalstudy |