Loretta Norton1, Raechelle M Gibson2, Teneille Gofton1, Carolyn Benson3, Sonny Dhanani4, Sam D Shemie5, Laura Hornby5, Roxanne Ward4, G Bryan Young1. 1. 1Program in Neurocritical Care,University of Western Ontario,London Health Sciences Centre,London,Ontario,Canada. 2. 3Department of Psychology,University of Western Ontario,London,Ontario,Canada. 3. 4Department of Clinical Neurological Sciences,London Health Sciences Centre,London,Ontario,Canada. 4. 5Division of Pediatric Critical Care,Children's Hospital of Eastern Ontario,Ottawa,ON,Canada. 5. 8Montreal Children's Hospital,McGill University Health Centre,Montreal,QC,Canada.
Abstract
BACKGROUND: The timing of the circulatory determination of death for organ donation presents a medical and ethical challenge. Concerns have been raised about the timing of electrocerebral inactivity in relation to the cessation of circulatory function in organ donation after cardio-circulatory death. Nonprocessed electroencephalographic (EEG) measures have not been characterized and may provide insight into neurological function during this process. METHODS: We assessed electrocortical data in relation to cardiac function after withdrawal of life-sustaining therapy and in the postmortem period after cardiac arrest for four patients in a Canadian intensive care unit. Subhairline EEG and cardio-circulatory monitoring including electrocardiogram, arterial blood pressure (ABP), and oxygen saturation were captured. RESULTS: Electrocerebral inactivity preceded the cessation of the cardiac rhythm and ABP in three patients. In one patient, single delta wave bursts persisted following the cessation of both the cardiac rhythm and ABP. There was a significant difference in EEG amplitude between the 30-minute period before and the 5-minute period following ABP cessation for the group, but we did not observe any well-defined EEG states following the early cardiac arrest period. CONCLUSIONS: In a case series of four patients, EEG inactivity preceded electrocardiogram and ABP inactivity during the dying process in three patients. Further study of the electroencephalogram during the withdrawal of life sustaining therapies will add clarity to medical, ethical, and legal concerns for donation after circulatory determined death.
BACKGROUND: The timing of the circulatory determination of death for organ donation presents a medical and ethical challenge. Concerns have been raised about the timing of electrocerebral inactivity in relation to the cessation of circulatory function in organ donation after cardio-circulatory death. Nonprocessed electroencephalographic (EEG) measures have not been characterized and may provide insight into neurological function during this process. METHODS: We assessed electrocortical data in relation to cardiac function after withdrawal of life-sustaining therapy and in the postmortem period after cardiac arrest for four patients in a Canadian intensive care unit. Subhairline EEG and cardio-circulatory monitoring including electrocardiogram, arterial blood pressure (ABP), and oxygen saturation were captured. RESULTS: Electrocerebral inactivity preceded the cessation of the cardiac rhythm and ABP in three patients. In one patient, single delta wave bursts persisted following the cessation of both the cardiac rhythm and ABP. There was a significant difference in EEG amplitude between the 30-minute period before and the 5-minute period following ABP cessation for the group, but we did not observe any well-defined EEG states following the early cardiac arrest period. CONCLUSIONS: In a case series of four patients, EEG inactivity preceded electrocardiogram and ABP inactivity during the dying process in three patients. Further study of the electroencephalogram during the withdrawal of life sustaining therapies will add clarity to medical, ethical, and legal concerns for donation after circulatory determined death.
Entities:
Keywords:
Critical care; Determination of death; Donation after circulatory death; EEG; Electrocerebral inactivity; Intensive care; Neurocritical care; Palliative care; Vital signs; withdrawal of life sustaining therapies
Authors: Beatriz Domínguez-Gil; Nancy Ascher; Alexander M Capron; Dale Gardiner; Alexander R Manara; James L Bernat; Eduardo Miñambres; Jeffrey M Singh; Robert J Porte; James F Markmann; Kumud Dhital; Didier Ledoux; Constantino Fondevila; Sarah Hosgood; Dirk Van Raemdonck; Shaf Keshavjee; James Dubois; Andrew McGee; Galen V Henderson; Alexandra K Glazier; Stefan G Tullius; Sam D Shemie; Francis L Delmonico Journal: Intensive Care Med Date: 2021-02-26 Impact factor: 17.440
Authors: Dylan T Lott; Tenzin Yeshi; N Norchung; Sonam Dolma; Nyima Tsering; Ngawang Jinpa; Tenzin Woser; Kunsang Dorjee; Tenzin Desel; Dan Fitch; Anna J Finley; Robin Goldman; Ana Maria Ortiz Bernal; Rachele Ragazzi; Karthik Aroor; John Koger; Andy Francis; David M Perlman; Joseph Wielgosz; David R W Bachhuber; Tsewang Tamdin; Tsetan Dorji Sadutshang; John D Dunne; Antoine Lutz; Richard J Davidson Journal: Front Psychol Date: 2021-01-28
Authors: Adu L Matory; Ayham Alkhachroum; Wei-Ting Chiu; Andrey Eliseyev; Kevin Doyle; Benjamin Rohaut; Jennifer A Egbebike; Angela G Velazquez; Caroline Der-Nigoghossian; Lucy Paniker; Kenneth M Prager; Sachin Agarwal; David Roh; Soojin Park; Jan Claassen Journal: Neurocrit Care Date: 2021-06-28 Impact factor: 3.210
Authors: Jens P Dreier; Sebastian Major; Brandon Foreman; Maren K L Winkler; Eun-Jeung Kang; Denny Milakara; Coline L Lemale; Vince DiNapoli; Jason M Hinzman; Johannes Woitzik; Norberto Andaluz; Andrew Carlson; Jed A Hartings Journal: Ann Neurol Date: 2018-02-15 Impact factor: 10.422