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Itagaki Y, Hayakawa M, Maekawa K, Kodate A, Moriki K, Takahashi Y, Sageshima H. Early prediction model of brain death in out-of-hospital cardiac arrest patients: a single-center retrospective and internal validation analysis. BMC Emerg Med 2022; 22:177. [PMID: 36333656 PMCID: PMC9636638 DOI: 10.1186/s12873-022-00734-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
Background A shortage of donor organs amid high demand for transplantable organs is a worldwide problem, and an increase in organ donation would be welcomed by the global healthcare system. Patients with brain death (BD) are potential organ donors, and early prediction of patients with BD may facilitate the process of organ procurement. Therefore, we developed a model for the early prediction of BD in patients who survived the initial phase of out-of-hospital cardiac arrest (OHCA). Methods We retrospectively analyzed data of patients aged < 80 years who experienced OHCA with a return of spontaneous circulation (ROSC) and were admitted to our hospital between 2006 and 2018. We categorized patients into either a non-BD or BD group. Demographic and laboratory data on ED admission were used for stepwise logistic regression analysis. Prediction scores of BD after OHCA were based on β-coefficients of prognostic factors identified in the multivariable logistic model. Results Overall, 419 OHCA patients with ROSC were admitted to our hospital during the study period. Seventy-seven patients showed BD (18.3%). Age and etiology of OHCA were significantly different between the groups. Logistic regression analysis confirmed that age, low-flow time, pH, and etiology were independent predictors of BD. The area under the receiver operating characteristic curve for this model was 0.831 (95% confidence interval, 0.786–0.876). Conclusions We developed and internally validated a new prediction model for BD after OHCA, which could aid in the early identification of potential organ donors for early donor organ procurement.
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Escudero D, Astola I, Balboa S, Leoz B, Meilan Á, Del Busto C, Quindós B, Forcelledo L, Vizcaino D, Martín L, Salgado E, Viña L. Clinico-radiological related to early brain death factors. Med Intensiva 2021; 46:1-7. [PMID: 34802992 DOI: 10.1016/j.medine.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 06/09/2020] [Accepted: 06/28/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify clinical and radiological factors associated to early evolution to brain death (BD), defined as occurring within the first 24 h. DESIGN A retrospective cohort study was made covering the period 2015-2017. SETTING An adult Intensive Care Unit (ICU). PATIENTS/METHODS Epidemiological, clinical and imaging (CT scan) parameters upon admission to the ICU in patients evolving to BD. RESULTS A total of 166 patients with BD (86 males, mean age 62.7 years) were analyzed. Primary cause: intracerebral hemorrhage 42.8%, subarachnoid hemorrhage 18.7%, traumatic brain injury 17.5%, anoxia 9%, stroke 7.8%, other causes 4.2%. Epidemiological data: arterial hypertension 50%, dyslipidemia 34%, smoking 33%, antiplatelet medication 21%, alcoholism 19%, anticoagulant therapy 15%, diabetes 15%. The Glasgow Coma Score (GCS) upon admission was 3 in 68.8% of the cases in early BD versus in 38.2% of the cases in BD occurring after 24 h (p = 0.0001). Eighty-five patients presented supratentorial hematomas with a volume of 90.9 ml in early BD versus 82.7 ml in BD > 24 h (p = 0.54). The mean midline shift was 10.7 mm in early BD versus 7.8 mm in BD > 24 h (p = 0.045). Ninety-one patients presented ventriculomegaly and 38 additionally ependymal transudation (p = 0.021). Thirty-six patients with early BD versus 24 with BD > 24 h presented complete effacement of basal cisterns (p = 0.005), sulcular effacement (p = 0.013), loss of cortico-subcortical differentiation (p = 0.0001) and effacement of the suprasellar cistern (p = 0.005). The optic nerve sheath measurements showed no significant differences between groups. CONCLUSIONS Early BD (>24 h) was associated to GCS < 5, midline shift, effacement of the basal cisterns, cerebral sulci and suprasellar cistern, and ependymal transudation.
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Affiliation(s)
- D Escudero
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - I Astola
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - S Balboa
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - B Leoz
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Á Meilan
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - C Del Busto
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - B Quindós
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - L Forcelledo
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - D Vizcaino
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - L Martín
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - E Salgado
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - L Viña
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
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Escudero D, Astola I, Balboa S, Leoz B, Meilan Á, Del Busto C, Quindós B, Forcelledo L, Vizcaino D, Martín L, Salgado E, Viña L. Clinico-radiological related to early brain death factors. Med Intensiva 2020; 46:S0210-5691(20)30249-7. [PMID: 32873408 DOI: 10.1016/j.medin.2020.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 06/09/2020] [Accepted: 06/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To identify clinical and radiological factors associated to early evolution to brain death (BD), defined as occurring within the first 24 hours. DESIGN A retrospective cohort study was made covering the period 2015-2017. SETTING An adult Intensive Care Unit (ICU). PATIENTS/METHODS Epidemiological, clinical and imaging (CT scan) parameters upon admission to the ICU in patients evolving to BD. RESULTS A total of 166 patients with BD (86 males, mean age 62.7 years) were analyzed. Primary cause: intracerebral hemorrhage 42.8%, subarachnoid hemorrhage 18.7%, traumatic brain injury 17.5%, anoxia 9%, stroke 7.8%, other causes 4.2%. Epidemiological data: arterial hypertension 50%, dyslipidemia 34%, smoking 33%, antiplatelet medication 21%, alcoholism 19%, anticoagulant therapy 15%, diabetes 15%. The Glasgow Coma Score (GCS) upon admission was 3 in 68.8% of the cases in early BD versus in 38.2% of the cases in BD occurring after 24 h (p = 0.0001). Eighty-five patients presented supratentorial hematomas with a volume of 90.9 ml in early BD versus 82.7 ml in BD >24 h (p = 0.54). The mean midline shift was 10.7 mm in early BD versus 7.8 mm in BD >24 h (p = 0.045). Ninety-one patients presented ventriculomegaly and 38 additionally ependymal transudation (p = 0.021). Thirty-six patients with early BD versus 24 with BD >24 h presented complete effacement of basal cisterns (p = 0.005), sulcular effacement (p = 0.013), loss of cortico-subcortical differentiation (p = 0.0001) and effacement of the suprasellar cistern (p = 0.005). The optic nerve sheath measurements showed no significant differences between groups. CONCLUSIONS Early BD (>24 h) was associated to GCS < 5, midline shift, effacement of the basal cisterns, cerebral sulci and suprasellar cistern, and ependymal transudation.
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Affiliation(s)
- D Escudero
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España.
| | - I Astola
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España
| | - S Balboa
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España
| | - B Leoz
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España
| | - Á Meilan
- Sección de Neurorradiología, Servicio de Radiología. Hospital Universitario Central de Asturias, Oviedo, España
| | - C Del Busto
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España
| | - B Quindós
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España
| | - L Forcelledo
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España
| | - D Vizcaino
- Sección de Neurorradiología, Servicio de Radiología. Hospital Universitario Central de Asturias, Oviedo, España
| | - L Martín
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España
| | - E Salgado
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España
| | - L Viña
- Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias, Oviedo, España
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Abstract
OBJECTIVES To systematically review the global published literature defining a potential deceased organ donor and identifying clinical triggers for deceased organ donation identification and referral. DATA SOURCES Medline and Embase databases from January 2006 to September 2017. STUDY SELECTION All published studies containing a definition of a potential deceased organ donor and/or clinical triggers for referring a potential deceased organ donor were eligible for inclusion. Dual, independent screening was conducted of 3,857 citations. DATA EXTRACTION Data extraction was completed by one team member and verified by a second team member. Thematic content analysis was used to identify clinical criteria for potential deceased organ donation identification from the published definitions and clinical triggers. DATA SYNTHESIS One hundred twenty-four articles were included in the review. Criteria fell into four categories: Neurological, Medical Decision, Cardiorespiratory, and Administrative. Distinct and globally consistent sets of clinical criteria by type of deceased organ donation (neurologic death determination, controlled donation after circulatory determination of death, and uncontrolled donation after circulatory determination of death) are reported. CONCLUSIONS Use of the clinical criteria sets reported will reduce ambiguity associated with the deceased organ donor identification and the subsequent referral process, potentially reducing the number of missed donors and saving lives globally through increased transplantation.
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Witjes M, Jansen NE, van der Hoeven JG, Abdo WF. Interventions aimed at healthcare professionals to increase the number of organ donors: a systematic review. Crit Care 2019; 23:227. [PMID: 31221214 PMCID: PMC6587298 DOI: 10.1186/s13054-019-2509-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/06/2019] [Indexed: 11/24/2022] Open
Abstract
Background The last decade, there have been many initiatives worldwide to increase the number of organ donors. However, it is not clear which initiatives are most effective. The aim of this study is to provide an overview of interventions aimed at healthcare professionals in order to increase the number of organ donors. Methods We systematically searched PubMed, EMBASE, CINAHL, PsycINFO, and the Cochrane Library for English language studies published until April 24, 2019. We included studies describing interventions in hospitals aimed at healthcare professionals who are involved in the identification, referral, and care of a family of potential organ donors. After the title abstract and full-text selection, two reviewers independently assessed each study’s quality and extracted data. Results From the 18,854 records initially extracted from five databases, we included 22 studies in our review. Of these 22 studies, 14 showed statistically significant effects on identification rate, family consent rate, and/or donation rate. Interventions that positively influenced one or more of these outcomes were training of emergency personnel in organ donation, an electronic support system to identify and/or refer potential donors, a collaborative care pathway, donation request by a trained professional, and additional family support in the ICU by a trained nurse. The methodological quality of the studies was relatively low, mainly because of the study designs. Conclusions Although there is paucity of data, collaborative care pathways, training of healthcare professionals and additional support for relatives of potential donors seem to be promising interventions to increase the number of organ donors. Trial registration PROSPERO, CRD42018068185 Electronic supplementary material The online version of this article (10.1186/s13054-019-2509-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marloes Witjes
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, Internal post 710, 6500 HB, Nijmegen, The Netherlands.,Dutch Transplant Foundation, Leiden, The Netherlands
| | | | - Johannes G van der Hoeven
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, Internal post 710, 6500 HB, Nijmegen, The Netherlands
| | - Wilson F Abdo
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, Internal post 710, 6500 HB, Nijmegen, The Netherlands.
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Evolution of Deceased Organ Donation Activity Versus Efficiency Over a 15-year Period: An International Comparison. Transplantation 2019; 102:1768-1778. [PMID: 29677069 DOI: 10.1097/tp.0000000000002226] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The donation rate (DR) per million population is not ideal for an efficiency comparison of national deceased organ donation programs. The DR does not account for variabilities in the potential for deceased donation which mainly depends on fatalities from causes leading to brain death. In this study, the donation activity was put into relation to the mortality from selected causes. Based on that metric, this study assesses the efficiency of different donation programs. METHODS This is a retrospective analysis of 2001 to 2015 deceased organ donation and mortality registry data. Included are 27 Council of Europe countries, as well as the United States. A donor conversion index (DCI) was calculated for assessing donation program efficiency over time and in international comparisons. RESULTS According to the DCI and of the countries included in the study, Spain, France, and the United States had the most efficient donation programs in 2015. Even though mortality from the selected causes decreased in most countries during the study period, differences in international comparisons persist. This indicates that the potential for deceased organ donation and its conversion into actual donation is far from being similar internationally. CONCLUSIONS Compared with the DR, the DCI takes into account the potential for deceased organ donation, and therefore is a more accurate metric of performance. National donation programs could optimize performance by identifying the areas where most potential is lost, and by implementing measures to tackle these issues.
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Escudero D, Valentín MO, Escalante JL, Sanmartín A, Perez-Basterrechea M, de Gea J, Martín M, Velasco J, Pont T, Masnou N, de la Calle B, Marcelo B, Lebrón M, Pérez JM, Burgos M, Gimeno R, Kot P, Yus S, Sancho I, Zabalegui A, Arroyo M, Miñambres E, Elizalde J, Montejo JC, Domínguez-Gil B, Matesanz R. Intensive care practices in brain death diagnosis and organ donation. Anaesthesia 2015; 70:1130-9. [PMID: 26040194 DOI: 10.1111/anae.13065] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2015] [Indexed: 12/30/2022]
Abstract
We conducted a multicentre study of 1844 patients from 42 Spanish intensive care units, and analysed the clinical characteristics of brain death, the use of ancillary testing, and the clinical decisions taken after the diagnosis of brain death. The main cause of brain death was intracerebral haemorrhage (769/1844, 42%), followed by traumatic brain injury (343/1844, 19%) and subarachnoid haemorrhage (257/1844, 14%). The diagnosis of brain death was made rapidly (50% in the first 24 h). Of those patients who went on to die, the Glasgow Coma Scale on admission was ≤ 8/15 in 1146/1261 (91%) of patients with intracerebral haemorrhage, traumatic brain injury or anoxic encephalopathy; the Hunt and Hess Scale was 4-5 in 207/251 (83%) of patients following subarachnoid haemorrhage; and the National Institutes of Health Stroke Scale was ≥ 15 in 114/129 (89%) of patients with strokes. Brain death was diagnosed exclusively by clinical examination in 92/1844 (5%) of cases. Electroencephalography was the most frequently used ancillary test (1303/1752, 70.7%), followed by transcranial Doppler (652/1752, 37%). Organ donation took place in 70% of patients (1291/1844), with medical unsuitability (267/553, 48%) and family refusal (244/553, 13%) the main reasons for loss of potential donors. All life-sustaining measures were withdrawn in 413/553 of non-donors (75%).
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Affiliation(s)
- D Escudero
- Intensive Care Unit, Central University Hospital of Asturias, Oviedo, Spain
| | - M O Valentín
- Spanish National Transplant Organization (ONT), Madrid, Spain
| | - J L Escalante
- Intensive Care Unit, Gregorio Marañón University Hospital, Madrid, Spain
| | - A Sanmartín
- Intensive Care Unit, Virgen de la Arrixaca Hospital, Murcia, Spain
| | - M Perez-Basterrechea
- Unit of Transplants, Cell Therapy and Regenerative Medicine, Central University Hospital of Asturias, Oviedo, Spain
| | - J de Gea
- Intensive Care Unit, Virgen de la Arrixaca Hospital, Murcia, Spain
| | - M Martín
- Intensive Care Unit, Central University Hospital of Asturias, Oviedo, Spain
| | - J Velasco
- Intensive Care Unit, Son Espases University Hospital, Palma de Mallorca, Spain
| | - T Pont
- Intensive Care Unit, Vall D'Hebron Hospital, Barcelona, Spain
| | - N Masnou
- Intensive Care Unit, Vall D'Hebron Hospital, Barcelona, Spain
| | - B de la Calle
- Intensive Care Unit, Gregorio Marañón University Hospital, Madrid, Spain
| | - B Marcelo
- Intensive Care Unit, Infanta Cristina University Hospital, Badajoz, Spain
| | - M Lebrón
- Intensive Care Unit, Carlos Haya Hospital, Málaga, Spain
| | - J M Pérez
- Intensive Care Unit, Virgen de las Nieves University Hospital, Granada, Spain
| | - M Burgos
- Intensive Care Unit, Virgen de las Nieves University Hospital, Granada, Spain
| | - R Gimeno
- Intensive Care Unit, La Fe University Hospital, Valencia, Spain
| | - P Kot
- Intensive Care Unit, La Paz University Hospital, Madrid, Spain
| | - S Yus
- Intensive Care Unit, La Paz University Hospital, Madrid, Spain
| | - I Sancho
- Intensive Care Unit, Miguel Servet University Hospital, Zaragoza, Spain
| | - A Zabalegui
- Intensive Care Unit, General Yagüe Hospital, Burgos, Spain
| | - M Arroyo
- Intensive Care Unit, General Yagüe Hospital, Burgos, Spain
| | - E Miñambres
- Intensive Care Unit, Marqués de Valdecilla University Hospital, Santander, Spain
| | - J Elizalde
- Intensive Care Unit, Asistential Complex of Navarra, Pamplona, Spain
| | - J C Montejo
- Intensive Care Unit, 12 de Octubre University Hospital, Madrid, Spain
| | - B Domínguez-Gil
- Spanish National Transplant Organization (ONT), Madrid, Spain
| | - R Matesanz
- Spanish National Transplant Organization (ONT), Madrid, Spain
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‘In plain language’: uniform criteria for organ donor recognition. Intensive Care Med 2013; 39:1492-4. [DOI: 10.1007/s00134-013-2986-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 05/28/2013] [Indexed: 01/22/2023]
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Galbois A, Boëlle PY, Hainque E, Raynal M, Cazejust J, Baudel JL, Ait-Oufella H, Alves M, Bigé N, Maury E, Guidet B, Offenstadt G. Prediction of evolution toward brain death upon admission to ICU in comatose patients with spontaneous intracerebral hemorrhage using simple signs. Transpl Int 2013; 26:517-26. [PMID: 23517301 DOI: 10.1111/tri.12084] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 11/18/2012] [Accepted: 02/11/2013] [Indexed: 12/12/2022]
Abstract
The aim of the study was to identify the predictors of brain death (BD) upon admission to the intensive care unit (ICU) of comatose patients with spontaneous intracerebral hemorrhage (ICH). Patients admitted in our ICU from 2002 to 2010 for spontaneous ICH and placed under mechanical ventilation were retrospectively analyzed. Of the 72 patients, 49% evolved to BD, 39% died after withdrawal of life support, and 12% were discharged alive. The most discriminating characteristics to predict BD were included in two models; Model 1 contained ≥3 abolished brainstem responses [adjusted odds ratios (OR) = 8.4 (2.4, 29.1)] and the swirl sign on the baseline CT-scan [adjusted OR = 5.0 (1.6, 15.9)] and Model 2 addressed the abolition of corneal reflexes [unilateral/bilateral: adjusted OR = 4.2 (0.9, 20.1)/8.8 (2.4, 32.3)] and the swirl sign on the baseline CT-scan [adjusted OR = 6.2 (1.9, 20.0)]. Two scores predicting BD were created (sensitivity: 0.89 and 0.88, specificity: 0.68 and 0.65). Risk of evolution toward BD was classified as low (corneal reflexes present and no swirl sign), high (≥1 corneal reflexes abolished and swirl sign), and intermediate. Simple signs at ICU admission can predict BD in comatose patients with ICH and could increase the potential for organ donation.
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Affiliation(s)
- Arnaud Galbois
- AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale, 75571 Paris Cedex 12, France.
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