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Brekelmans ACM, Ramnarain D, Pouwels S. Bereavement Support Programs in the Intensive Care Unit: A Systematic Review. J Pain Symptom Manage 2022; 64:e149-e157. [PMID: 35618249 DOI: 10.1016/j.jpainsymman.2022.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/09/2022] [Accepted: 05/19/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The death of a loved one in the intensive care unit (ICU) may have a psychological impact on relatives of deceased ICU patients. The first aim of this review is to give an overview of different bereavement support strategies and possible different effects on anxiety, depression, Post-traumatic Stress Disorder (PTSD), and complicated grief. Secondly to assess if there is a difference in organization among bereavement support strategies mentioned in literature. METHODS A multi-database search (Pubmed, Web of Science, PsychInfo, Medline, and Embase) was conducted until February 6, 2021. Articles were screened and selected by two independent researchers. Methodological quality of the included articles was assessed using the Delphi List for Quality Assessment of Randomized Clinical Trials and the Newcastle-Ottawa scale (NOS) for nonrandomized trials. RESULTS The primary literature search revealed 1668 articles, including 769 duplicates. Seven articles were included in this review, of which six were randomized controlled trials and one was a prospective cross-sectional study. We found that a bereavement strategy consisting of a communication strategy and a brochure lowered the appearance of symptoms of PTSD, anxiety, and depression. A brochure, condolence card, and phone call as bereavement support can lower the risk of prolonged grief. Receiving information about CPR and getting the choice to attend CPR led to fewer frequencies of PTSD, depression, and traumatic/complicated grief. SIGNIFICANCE OF RESULTS A bereavement strategy consisting of multiple parts, including family participation and a brochure may reduce the levels of anxiety, depression, PTSD, and/or complicated bereavement in family members of deceased ICU patients.
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Affiliation(s)
- A C M Brekelmans
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, (A.C.M.B, D.R., S.P) The Netherlands
| | - Dharmanand Ramnarain
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, (A.C.M.B, D.R., S.P) The Netherlands; Department of Intensive Care Medicine, Saxenburg Medical Centre, Hardenberg, (D.R.) The Netherlands
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, (A.C.M.B, D.R., S.P) The Netherlands.
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Yu SS, Jin J, Yao RQ, Wang BL, Hu LY, Wu GS, Sun Y. Association of Preadmission Statin Use and Mortality in Critically Ill Patients: A Meta-Analysis of Cohort Studies. Front Med (Lausanne) 2021; 8:656694. [PMID: 34124094 PMCID: PMC8193232 DOI: 10.3389/fmed.2021.656694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/05/2021] [Indexed: 01/11/2023] Open
Abstract
Background: A large number of studies have been conducted to determine whether there is an association between preadmission statin use and improvement in outcomes following critical illness, but the conclusions are quite inconsistent. Therefore, this meta-analysis aims to include the present relevant PSM researches to examine the association of preadmission use of statins with the mortality of critically ill patients. Methods: The PubMed, Web of Science, Embase electronic databases, and printed resources were searched for English articles published before March 6, 2020 on the association between preadmission statin use and mortality in critically ill patients. The included articles were analyzed in RevMan 5.3. The Newcastle-Ottawa Scale (NOS) was used to conduct quality evaluation, and random/fixed effects modeling was used to calculate the pooled ORs and 95% CIs. We also conducted subgroup analysis by outcome indicators (30-, 90-day, hospital mortality). Results: All six PSM observational studies were assessed as having a low risk of bias according to the NOS. For primary outcome-overall mortality, the pooled OR (preadmission statins use vs. no use) across the six included studies was 0.86 (95% CI, 0.76-0.97; P = 0.02). For secondary outcome-use of mechanical ventilation, the pooled OR was 0.94 (95% CI, 0.91-0.97; P = 0.0005). The corresponding pooled ORs were 0.67 (95% CI, 0.43-1.05; P = 0.08), 0.91 (95% CI, 0.83-1.01; P = 0.07), and 0.86 (95% CI, 0.83-0.89; P < 0.00001) for 30-, 90-day, and hospital mortality, respectively. Conclusions: Preadmission statin use is associated with beneficial outcomes in critical ill patients, indicating a lower short-term mortality, less use of mechanical ventilation, and an improvement in hospital survival. Further high-quality original studies or more scientific methods are needed to draw a definitive conclusion.
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Affiliation(s)
- Shao-Shuo Yu
- Department of Burn Surgery, Changhai Hospital, The Naval University, Shanghai, China
| | - Jian Jin
- Department of Burn and Plastic Surgery, 903rd Hospital of the Chinese People's Liberation Army (PLA), Hangzhou, China
| | - Ren-Qi Yao
- Department of Burn Surgery, Changhai Hospital, The Naval University, Shanghai, China
| | - Bo-Li Wang
- Department of Burn Surgery, Changhai Hospital, The Naval University, Shanghai, China
| | - Lun-Yang Hu
- Department of Burn Surgery, Changhai Hospital, The Naval University, Shanghai, China
| | - Guo-Sheng Wu
- Department of Burn Surgery, Changhai Hospital, The Naval University, Shanghai, China
| | - Yu Sun
- Department of Burn Surgery, Changhai Hospital, The Naval University, Shanghai, China
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Effect of atorvastatin on the incidence of acute kidney injury following valvular heart surgery: a randomized, placebo-controlled trial. Intensive Care Med 2016; 42:1398-407. [DOI: 10.1007/s00134-016-4358-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 04/15/2016] [Indexed: 10/21/2022]
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Clark E, Kumar A, Langote A, Lapinsky S, Dodek P, Kramer A, Wood G, Bagshaw SM, Wood K, Gurka D, Sood MM. Septic shock in chronic dialysis patients: clinical characteristics, antimicrobial therapy and mortality. Intensive Care Med 2015; 42:222-32. [DOI: 10.1007/s00134-015-4147-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 11/10/2015] [Indexed: 01/13/2023]
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Tsai MJ, Ou SM, Shih CJ, Chao PW, Wang LF, Shih YN, Li SY, Kuo SC, Hsu YT, Chen YT. Association of prior antiplatelet agents with mortality in sepsis patients: a nationwide population-based cohort study. Intensive Care Med 2015; 41:806-13. [PMID: 25829229 DOI: 10.1007/s00134-015-3760-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/16/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Antiplatelet agents are widely used for cardiovascular disea ses, but their pleiotropic effects in sepsis are controversial. OBJECTIVE To investigate the association between antiplatelet agents and the survival benefit for sepsis patients. DESIGN A nationwide population-based cohort and nested case-control study. SETTING Taiwan National Health Insurance database. PARTICIPANTS All patients (age ≥18 years) who were hospitalized for sepsis between January 2000 and December 2010. MEASUREMENTS Conditional logistic regression was used to adjust for confounding. Adjusted odd ratios (ORs) were used to compare the mortality rate due to sepsis in antiplatelet drug users and nonusers. RESULTS Of 683,421 included patients, 229,792 (33.6 %) patients died during hospitalization for sepsis, and the rest (64.4 %) survived to discharge. Use of antiplatelet agents before admission was associated with a lower risk of mortality in sepsis patients (aOR 0.82, 95 % confidence interval [CI] 0.81-0.83, P < 0.001). By using another case-control study design, the beneficial effect was more significant in current users (aOR 0.78, 95 % CI 0.76-0.79) than in recent users (aOR 0.88, 95 % CI 0.85-0.91), but was not significant in past users (aOR 1.00, 95 % CI 0.98-1.02). LIMITATIONS Observational study. CONCLUSIONS Prior use of antiplatelet agents was associated with a survival benefit in sepsis patients.
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Affiliation(s)
- Min-Juei Tsai
- Department of Internal Medicine, Taipei Veterans General Hospital, Suao Branch, Yilan, Taiwan
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Safety and feasibility of a strategy of early central venous catheter insertion in a deployed UK military Ebola virus disease treatment unit. Intensive Care Med 2015; 41:735-43. [DOI: 10.1007/s00134-015-3736-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/04/2015] [Indexed: 01/08/2023]
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Kang BJ, Koh Y, Lim CM, Huh JW, Baek S, Han M, Seo HS, Suh HJ, Seo GJ, Kim EY, Hong SB. Failure of high-flow nasal cannula therapy may delay intubation and increase mortality. Intensive Care Med 2015; 41:623-32. [DOI: 10.1007/s00134-015-3693-5] [Citation(s) in RCA: 304] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 02/06/2015] [Indexed: 01/13/2023]
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Colpaert K, Oeyen S, Sijnave B, Peleman R, Benoit D, Decruyenaere J. Influence of smart real-time electronic alerting on glucose control in critically ill patients. J Crit Care 2014; 30:216.e1-6. [PMID: 25194590 DOI: 10.1016/j.jcrc.2014.07.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/24/2014] [Accepted: 07/27/2014] [Indexed: 01/18/2023]
Abstract
PURPOSE Hyperglycemia and hypoglycemia are frequently encountered in critically ill patients and associated with adverse outcomes. We configured a smart glycemia alert (S-GLY alert) with our Intensive Care Information System to decrease the number of hyperglycemic values and increase the proportion of time within the glucose interval of 80 to 150 mg/dL. MATERIALS AND METHODS Prospective intervention study in surgical intensive care unit in a tertiary care hospital. An 11-week prealert phase was followed by a 15-week intervention phase where the S-GLY alert was alerting the nurses through the Clinical Notification System of the Intensive Care Information System. RESULTS Overall, 2335 S-GLY alerts were recorded. There were less hyperglycemic values and less persistent hyperglycemic episodes in the alert phase (19.5% vs 26.5% [P < .001] and 9.9% vs 15.4% [P < .001], respectively). More time was spent within target glucose interval (82.3% vs 75.0%, P = .009). A lower proportion of patients experienced a new-onset hypoglycemic event (<70 mg/dL) in the alert phase (9.2% vs 15.2%, P = .016). The Sequential Organ Failure Assessment score was significantly reduced (5.2 vs 4.2, P < .001). CONCLUSIONS The implementation of a real-time smart electronic glycemia alert resulted in significantly less episodes of persistent hyperglycemia and a higher proportion of time with normoglycemia, while decreasing the number of hypoglycemic events.
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Affiliation(s)
- Kirsten Colpaert
- Department of Intensive Care, Ghent University Hospital, Ghent, Belgium.
| | - Sandra Oeyen
- Department of Intensive Care, Ghent University Hospital, Ghent, Belgium.
| | - Bart Sijnave
- Department of Information Technology, Ghent University Hospital, Ghent, Belgium.
| | - Renaat Peleman
- Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium.
| | - Dominique Benoit
- Department of Intensive Care, Ghent University Hospital, Ghent, Belgium.
| | - Johan Decruyenaere
- Department of Intensive Care, Ghent University Hospital, Ghent, Belgium.
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Ou SY, Chu H, Chao PW, Ou SM, Lee YJ, Kuo SC, Li SY, Shih CJ, Chen YT. Effect of the use of low and high potency statins and sepsis outcomes. Intensive Care Med 2014; 40:1509-17. [PMID: 25091791 DOI: 10.1007/s00134-014-3418-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 07/23/2014] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Although statins have been shown to have cholesterol-lowering effects, their pleiotropic benefits on sepsis remain a matter of debate. In addition, the influence of statin potency on sepsis-related mortality has never been explored. The aim of our study was to determine the sepsis outcomes of low- and high-potency statin users and non-users. METHODS This nationwide, population-based, propensity score-matched analysis used data from the linked administrative databases of Taiwan's National Health Insurance program. Patients were hospitalized for sepsis between 2000 and 2010. All-cause mortality and major adverse consequences of sepsis, such as in-hospital death, intensive care unit admission, shock events, and the use of mechanical ventilation, were assessed. Patients were divided into high-potency statin users (at least 10 mg rosuvastatin, at least 20 mg atorvastatin, or at least 40 mg simvastatin), low-potency statin users (all other statin treatments), and non-users. RESULTS A propensity score-matched cohort of 27,792 statin users and 27,792 non-users was included. Of 27,792 statin users, 9,785 (35.2 %) were treated with high-potency statins and 18,007 (64.8 %) were treated with low-potency statins. The 1-year mortality risk was significantly lower among both low-potency [adjusted hazard ratio (aHR) 0.89, 95 % confidence interval (CI) 0.85-0.93] and high-potency (aHR 0.80, 95 % CI 0.75-0.86) statin users compared with non-users. The risks of mortality and adverse consequences of sepsis were lower among high-potency than among low-potency statin users. CONCLUSIONS High-potency statin use is associated with a lower risk of sepsis-related mortality compared with low-potency statin use.
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Affiliation(s)
- Shu-Yu Ou
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Plummer MP, Bellomo R, Cousins CE, Annink CE, Sundararajan K, Reddi BAJ, Raj JP, Chapman MJ, Horowitz M, Deane AM. Dysglycaemia in the critically ill and the interaction of chronic and acute glycaemia with mortality. Intensive Care Med 2014; 40:973-80. [PMID: 24760120 DOI: 10.1007/s00134-014-3287-7] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 04/01/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE Hyperglycaemia is common in the critically ill. The objectives of this study were to determine the prevalence of critical illness-associated hyperglycaemia (CIAH) and recognised and unrecognised diabetes in the critically ill as well as to evaluate the impact of premorbid glycaemia on the association between acute hyperglycaemia and mortality. METHODS In 1,000 consecutively admitted patients we prospectively measured glycated haemoglobin (HbA1c) on admission, and blood glucose concentrations during the 48 h after admission, to the intensive care unit. Patients with blood glucose ≥7.0 mmol/l when fasting or ≥11.1 mmol/l during feeding were deemed hyperglycaemic. Patients with acute hyperglycaemia and HbA1c <6.5% (48 mmol/mol) were categorised as 'CIAH', those with known diabetes as 'recognised diabetes', and those with HbA1c ≥6.5% but no previous diagnosis of diabetes as 'unrecognised diabetes'. The remainder were classified as 'normoglycaemic'. Hospital mortality, HbA1c and acute peak glycaemia were assessed using a logistic regression model. RESULTS Of 1,000 patients, 498 (49.8%) had CIAH, 220 (22%) had recognised diabetes, 55 (5.5%) had unrecognised diabetes and 227 (22.7%) were normoglycaemic. The risk of death increased by approximately 20% for each increase in acute glycaemia of 1 mmol/l in patients with CIAH and those with diabetes and HbA1c levels <7% (53 mmol/mol), but not in patients with diabetes and HbA1c ≥7%. This association was lost when adjusted for severity of illness. CONCLUSIONS Critical illness-associated hyperglycaemia is the most frequent cause of hyperglycaemia in the critically ill. Peak glucose concentrations during critical illness are associated with increased mortality in patients with adequate premorbid glycaemic control, but not in patients with premorbid hyperglycaemia. Optimal glucose thresholds in the critically ill may, therefore, be affected by premorbid glycaemia.
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Affiliation(s)
- Mark P Plummer
- Department of Critical Care Services, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia
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Jabre P, Tazarourte K, Azoulay E, Borron SW, Belpomme V, Jacob L, Bertrand L, Lapostolle F, Combes X, Galinski M, Pinaud V, Destefano C, Normand D, Beltramini A, Assez N, Vivien B, Vicaut E, Adnet F. Offering the opportunity for family to be present during cardiopulmonary resuscitation: 1-year assessment. Intensive Care Med 2014; 40:981-7. [PMID: 24852952 DOI: 10.1007/s00134-014-3337-1] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 05/07/2014] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate the psychological consequences among family members given the option to be present during the CPR of a relative, compared with those not routinely offered the option. METHODS Prospective, cluster-randomized, controlled trial involving 15 prehospital emergency medical services units in France, comparing systematic offer for a relative to witness CPR with the traditional practice among 570 family members. Main outcome measure was 1-year assessment included proportion suffering post-traumatic stress disorder (PTSD), anxiety and depression symptoms, and/or complicated grief. RESULTS Among the 570 family members [intention to treat (ITT) population], 408 (72%) were evaluated at 1 year. In the ITT population (N = 570), family members had PTSD-related symptoms significantly more frequently in the control group than in the intervention group [adjusted odds ratio, 1.8; 95% confidence interval (CI) 1.1-3.0; P = 0.02] as did family members to whom physicians did not propose witnessing CPR [adjusted odds ratio, 1.7; 95% CI 1.1-2.6; P = 0.02]. In the observed cases population (N = 408), the proportion of family members experiencing a major depressive episode was significantly higher in the control group (31 vs. 23%; P = 0.02) and among family members to whom physicians did not propose the opportunity to witness CPR (31 vs. 24%; P = 0.03). The presence of complicated grief was significantly greater in the control group (36 vs. 21%; P = 0.005) and among family members to whom physicians did not propose the opportunity to witness resuscitation (37 vs. 23%; P = 0.003). CONCLUSIONS At 1 year after the event, psychological benefits persist for those family members offered the possibility to witness the CPR of a relative in cardiac arrest.
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Affiliation(s)
- Patricia Jabre
- AP-HP, Urgences-Samu 93, Hôpital Avicenne, Université Paris 13, 93000, Bobigny, France
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Saigal S, Kapoor G. Ulinastatin: is it worth using in severe sepsis? Intensive Care Med 2014; 40:1185. [PMID: 24845579 DOI: 10.1007/s00134-014-3341-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2014] [Indexed: 01/13/2023]
Affiliation(s)
- Saurabh Saigal
- Department of Trauma and Emergency Medicine, AIIMS, Bhopal, 462024, India,
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What's new in organ donation: better care of the dead for the living. Intensive Care Med 2013; 39:2031-3. [PMID: 23912380 DOI: 10.1007/s00134-013-3038-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 07/19/2013] [Indexed: 12/13/2022]
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The incidence of potential missed organ donors in intensive care units and emergency rooms: a retrospective cohort. Intensive Care Med 2013; 39:1452-9. [PMID: 23702637 DOI: 10.1007/s00134-013-2952-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 05/03/2013] [Indexed: 01/14/2023]
Abstract
PURPOSE There is a shortage of organ donors in Canada. The number of potential organ donors that are not referred to organ procurement organizations in Canada is unknown. METHODS We conducted a retrospective cohort study of all deaths in ICUs and emergency rooms not referred to the Human Organ Procurement and Exchange Program in four hospitals between 1 January 2008 and 31 December 2010. The primary outcome was the number of normal and expanded criteria heart-beating donors and circulatory death (DCD) donors. RESULTS Of 2,931 deaths, 64 patients were identified as having a high probability for progression to heart-beating donation (Glasgow Coma Score of 3 and three or more absent brainstem reflexes) and 130 patients were assessed for possible DCD donation. The number of potential abdominal and lung heart-beating donors ranged from 3.2 to 7.5 and 0.5 to 2.7 per million population. The number of potential DCD abdominal and lung donors ranged from 3.9 to 6.5 and 2.7 to 4.3 per million population. Potential heart-beating abdominal (p = 0.04) and lung (p = 0.06) donors increased after legislation mandating donation discussion. Non-pupillary brainstem reflexes were documented in fewer than 60 % of records. Life-sustaining treatment was withdrawn in 19 of 46 (41.3 %) cardiac arrest patients not requiring high doses of vasoactive drugs within 24 h. CONCLUSION The number of heart-beating or DCD organ donors represented by missed referrals may represent up to 7.5 donors per million population. Improved documentation of brainstem reflexes and encouraging referral of patients suffering cardiac arrest to ICU specialists may improve donor numbers.
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