| 11. |
- Sandroni, Claudio, et al.
(författare)
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The rate of brain death and organ donation in patients resuscitated from cardiac arrest : a systematic review and meta-analysis
- 2016
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Ingår i: Intensive Care Medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 42:11, s. 1661-1671
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Forskningsöversikt (refereegranskat)abstract
- Background: The occurrence of brain death in patients with hypoxic-ischaemic brain injury after resuscitation from cardiac arrest creates opportunities for organ donation. However, its prevalence is currently unknown. Methods: Systematic review. MEDLINE via PubMed, ISI Web of Science and the Cochrane Database of Systematic Reviews were searched for eligible studies (2002–2016). The prevalence of brain death in adult patients resuscitated from cardiac arrest and the rate of organ donation among brain dead patients were summarised using a random effect model with double-arcsine transformation. The quality of evidence (QOE) was evaluated according to the GRADE guidelines. Results: 26 studies [16 on conventional cardiopulmonary resuscitation (c-CPR), 10 on extracorporeal CPR (e-CPR)] included a total of 23,388 patients, 1830 of whom developed brain death at a mean time of 3.2 ± 0.4 days after recovery of circulation. The overall prevalence of brain death among patients who died before hospital discharge was 12.6 [10.2–15.2] %. Prevalence was significantly higher in e-CPR vs. c-CPR patients (27.9 [19.7–36.6] vs. 8.3 [6.5–10.4] %; p < 0.0001). The overall rate of organ donation among brain dead patients was 41.8 [20.2–51.0] % (9/26 studies, 1264 patients; range 0–100 %). The QOE was very low for both outcomes. Conclusions: In patients with hypoxic-ischaemic brain injury following CPR, more than 10 % of deaths were due to brain death. More than 40 % of brain-dead patients could donate organs. Patients who are unconscious after resuscitation from cardiac arrest, especially when resuscitated using e-CPR, should be carefully screened for signs of brain death.
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| 12. |
- Steinberg, Alexis, et al.
(författare)
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Prognostication after cardiac arrest : Results of an international, multi-professional survey
- 2019
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Ingår i: Resuscitation. - : Elsevier BV. - 0300-9572. ; 138, s. 190-197
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Tidskriftsartikel (refereegranskat)abstract
- Aim: We explored preferences for prognostic test performance characteristics and error tolerance in decisions regarding withdrawal or continuation of life-sustaining therapy (LST) after cardiac arrest in a diverse cohort of medical providers. Methodology: We distributed a survey through professional societies and research networks. We asked demographic characteristics, preferences for prognostic test performance characteristics and views on acceptable false positive rates for decisions about LST after cardiac arrest. Results: Overall, 640 respondents participated in our survey. Most respondents were attending physicians (74%) with >10 years of experience (59%) and practiced at academic centers (77%). Common specialties were neurology (22%), neuro- or general critical care (24%) and palliative care (31%). The majority (56%) felt an acceptable FPR for withdrawal of LST from patients who might otherwise have recovered was ≤0.1%. Acceptable FPRs for continuing LST in patients with unrecognized irrecoverable injury was higher, with 59% choosing a threshold ≤1%. Compared to providers with >10 years of experience, those with <5 years thought lower FPRs were acceptable (P < 0.001 for both). Palliative care providers accepted significantly higher FPRs for withdrawal of LST (P < 0.0001), and critical care providers accepted significantly higher FPRs for provision of long-term LST (P = 0.02). With regard to test performance characteristics, providers favored accuracy over timeliness, and prefer tests be optimized to predictrather than favorable outcomes. Conclusion: Medical providers are comfortable with low acceptable FPR for withdrawal (≤0.1%) and continuation (≤1%) of LST after cardiac arrest. These FPRs may be lower than can be achieved with current prognostic modalities.
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