Changes in Life-Sustaining Treatment Limitations in Swedish ICUs During the COVID-19 Pandemic

Background The use of limitations of life-sustaining treatment (LLST) in Intensive Care Units (ICUs) varies internationally. The COVID-19 pandemic led to significant changes worldwide, but its impact on ICU LLST remains unclear. This study aimed to assess the prevalence of LLST in Swedish ICUs from 2018 to 2022 and whether the pandemic and COVID-19 influenced their utilization. Methods All ICU admissions registered in the Swedish Intensive Care Registry from 2018–2022 were screened. Cases with post-anesthesia care of less than 24 hours and subsequent ICU admissions were excluded. Logistic regression was used to analyze associations with LLST, defined as any limitation of therapy, including withholding or withdrawing therapy. March 16, 2020, marked the start of the pandemic. Results In total, 77 735 ICU admissions were analyzed: 39 396 pre-pandemic and 38 338 during the pandemic. Patients admitted during the pandemic had slightly higher odds (OR 1.06, 95% CI 1.03–1.10, p < 0.001) of receiving LLST compared to before the pandemic. COVID-19 patients had an increased odds of receiving a LLST compared to non COVID-19 patients (OR 1.17, 95% CI 1.09–1.25, p < 0.001). ICU capacity utilization was not associated with LLST use in our study. Conclusions The findings suggest a shift in LLST use, with increased odds during the pandemic and among COVID-19 patients specifically. This may reflect greater attention to active decision-making regarding life-sustaining therapy during this period.