Cerebral cortical activity after withdrawal of life-sustaining measures in critically ill patients.
clinical research/practice
donors and donation: deceased
donors and donation: donation after circulatory death (DCD)
electroencephalography
neurology
Journal
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
ISSN: 1600-6143
Titre abrégé: Am J Transplant
Pays: United States
ID NLM: 100968638
Informations de publication
Date de publication:
12 2022
12 2022
Historique:
revised:
09
06
2022
received:
10
01
2022
accepted:
04
07
2022
pubmed:
14
7
2022
medline:
6
12
2022
entrez:
13
7
2022
Statut:
ppublish
Résumé
Establishing when cerebral cortical activity stops relative to circulatory arrest during the dying process will enhance trust in donation after circulatory determination of death. We used continuous electroencephalography and arterial blood pressure monitoring prior to withdrawal of life sustaining measures and for 30 min following circulatory arrest to explore the temporal relationship between cessation of cerebral cortical activity and circulatory arrest. Qualitative and quantitative EEG analyses were completed. Among 140 screened patients, 52 were eligible, 15 were enrolled, 11 completed the full study, and 8 (3 female, median age 68 years) were included in the analysis. Across participants, EEG activity stopped at a median of 78 (Q1 = -387, Q3 = 111) seconds before circulatory arrest. Following withdrawal of life sustaining measures there was a progressive reduction in electroencephalographic amplitude (p = .002), spectral power (p = .008), and coherence (p = .003). Prospective recording of cerebral cortical activity in imminently dying patients is feasible. Our results from this small cohort suggest that cerebral cortical activity does not persist after circulatory arrest. Confirmation of these findings in a larger multicenter study are needed to help promote stakeholder trust in donation after circulatory determination of death.
Identifiants
pubmed: 35822321
doi: 10.1111/ajt.17146
pii: S1600-6135(23)00064-3
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
3120-3129Subventions
Organisme : CIHR
Pays : Canada
Informations de copyright
© 2022 The American Society of Transplantation and the American Society of Transplant Surgeons.
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