M A Bodí1, T Pont2, A Sandiumenge3, E Oliver4, J Gener5, M Badía6, J Mestre7, E Muñoz8, X Esquirol9, M Llauradó3, J Twose10, S Quintana11. 1. Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Universitat Rovira i Virgili, Institut Investigació Sanitària Pere Virgili, Tarragona, España. Electronic address: mbodi.hj23.ics@gencat.cat. 2. Coordinación de Trasplantes, Hospital Universitario Vall d'Hebrón, Barcelona, España. 3. Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Universitat Rovira i Virgili, Institut Investigació Sanitària Pere Virgili, Tarragona, España. 4. Coordinación de Trasplantes, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España. 5. Servicio de Medicina Intensiva, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, España. 6. Servicio de Medicina Intensiva, Hospital Universitario Arnau de Vilanova de Lleida, Lérida, España. 7. Servicio de Medicina Intensiva, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España. 8. Servicio de Medicina Intensiva, Hospital Sant Pau i Santa Tecla, Tarragona, España. 9. Servicio de Medicina Intensiva, Hospital de Granollers, Granollers, Barcelona, España. 10. Organización Catalana de Trasplantes, Barcelona, España. 11. Servicio de Medicina Intensiva, Hospital Mutua de Terrassa, Terrassa, Barcelona, España.
Abstract
OBJECTIVE: To analyze the profile, incidence of life support therapy limitation (LSTL) and donation potential in neurocritical patients. STUDY DESIGN: A multicenter prospective study was carried out. SETTING: Nine hospitals authorized for organ harvesting for transplantation. PATIENTS: All patients consecutively admitted to the hospital with GCS < 8 during a 6-month period were followed-up until discharge or day 30 of hospital stay. STUDY VARIABLES: Demographic data, cause of coma, clinical status upon admission and outcome were analyzed. LSTL, brain death (BD) and organ donation incidence were recorded. RESULTS: A total of 549 patients were included, with a mean age of 59.0 ± 14.5 years. The cause of coma was cerebral hemorrhage in 27.0% of the cases.LSTL was applied in 176 patients (32.1%). In 78 cases LSTL consisted of avoiding ICU admission. Age, the presence of contraindications, and specific causes of coma were associated to LSTL. A total of 58.1% of the patients died (n=319). One-hundred and thirty-three developed BD (24.2%), and 56.4% of these became organ donors (n=75). The presence of edema and mid-line shift on the CT scan, and transplant coordinator evaluation were associated to BD. LSTL was associated to a no-BD outcome. Early LSTL (first 4 days) was applied in 9 patients under 80 years of age, with no medical contraindications for donation and a GCS ≤ 4 who finally died in asystole. CONCLUSIONS: LSTL is a frequent practice in neurocritical patients. In almost one-half of the cases, LSTL consisted of avoiding admission to the ICU, and on several occasions the donation potential was not evaluated by the transplant coordinator.
OBJECTIVE: To analyze the profile, incidence of life support therapy limitation (LSTL) and donation potential in neurocritical patients. STUDY DESIGN: A multicenter prospective study was carried out. SETTING: Nine hospitals authorized for organ harvesting for transplantation. PATIENTS: All patients consecutively admitted to the hospital with GCS < 8 during a 6-month period were followed-up until discharge or day 30 of hospital stay. STUDY VARIABLES: Demographic data, cause of coma, clinical status upon admission and outcome were analyzed. LSTL, brain death (BD) and organ donation incidence were recorded. RESULTS: A total of 549 patients were included, with a mean age of 59.0 ± 14.5 years. The cause of coma was cerebral hemorrhage in 27.0% of the cases.LSTL was applied in 176 patients (32.1%). In 78 cases LSTL consisted of avoiding ICU admission. Age, the presence of contraindications, and specific causes of coma were associated to LSTL. A total of 58.1% of the patients died (n=319). One-hundred and thirty-three developed BD (24.2%), and 56.4% of these became organ donors (n=75). The presence of edema and mid-line shift on the CT scan, and transplant coordinator evaluation were associated to BD. LSTL was associated to a no-BD outcome. Early LSTL (first 4 days) was applied in 9 patients under 80 years of age, with no medical contraindications for donation and a GCS ≤ 4 who finally died in asystole. CONCLUSIONS: LSTL is a frequent practice in neurocritical patients. In almost one-half of the cases, LSTL consisted of avoiding admission to the ICU, and on several occasions the donation potential was not evaluated by the transplant coordinator.
Keywords:
Brain Death; Donación de órganos; Life Support Therapy Limitation; Limitación tratamiento de soporte vital; Muerte Encefálica; Organ Donation; Potencialidad; Potential
Authors: Antonio Sánchez-Vallejo; Juan Gómez-Salgado; María Nélida Fernández-Martínez; Daniel Fernández-García Journal: Int J Environ Res Public Health Date: 2018-10-04 Impact factor: 3.390