Evidence-Based Checklist to Delay Cardiac Arrest in Brain-Dead Potential Organ Donors

被引：3

作者：

Westphal, Glauco A. ^{[1
,2
,3
,4
]}

Robinson, Caroline Cabral ^{[1
]}

Giordani, Natalia Elis ^{[1
,5
]}

Teixeira, Cassiano ^{[6
,7
]}

Rohden, Adriane Isabel

dos Passos Gimenes, Bruna ^{[1
]}

Guterres, Catia Moreira ^{[1
]}

Madalena, Itiana Cardoso ^{[1
]}

Andrighetto, Luiza Vitelo ^{[1
]}

Souza da Silva, Sabrina ^{[1
]}

Barbosa da Silva, Daiana ^{[1
]}

Sganzerla, Daniel ^{[1
]}

Cavalcanti, Alexandre Biasi ^{[8
]}

Franke, Cristiano Augusto ^{[6
,9
]}

Bozza, Fernando Augusto ^{[10
,11
]}

Machado, Flavia Ribeiro ^{[12
]}

de Andrade, Joel ^{[2
]}

Pontes Azevedo, Luciano Cesar ^{[13
]}

Schneider, Silvana ^{[14
]}

Orlando, Bianca Rodrigues ^{[15
,16
]}

Grion, Cintia Magalhaes Carvalho ^{[17
,18
]}

Bezerra, Fernando Albuerne ^{[19
]}

Roman, Fernando Roberto ^{[20
]}

Leite, Francisco Olon ^{[21
]}

Ferraz Siqueira, Iris Lima ^{[22
]}

Oliveira, Joao Fernando Piccolo ^{[23
]}

de Oliveira, Lucio Couto ^{[24
]}

de Melo, Maria de Fatima Rodrigues Buarque ^{[25
]}

Leal, Patricia Berg Goncalves Pereira ^{[26
]}

Diniz, Pedro Carvalho ^{[27
]}

Moraes, Rafael Barbarena ^{[28
]}

Salomao Pontes, Daniela Ferreira ^{[29
]}

Araujo Queiroz, Joselio Emar ^{[29
]}

Hammes, Luciano Serpa ^{[1
]}

Meade, Maureen O. ^{[30
]}

Rosa, Regis Goulart ^{[1
]}

Falavigna, Maicon ^{[1
,31
,32
]}

机构：

[1] Hosp Moinhos de Vento HMV, Responsabilidade Social Programa Apoio Desenvolvi, Porto Alegre, RS, Brazil

[2] Cent Estadual Transplantes Santa Catarina, Rua Esteves Jr, Florianopolis, SC, Brazil

[3] Ctr Hosp Unimed Joinville, Joinville, SC, Brazil

[4] Hosp Municipal Sao Jose, Joinville, SC, Brazil

[5] Univ Fed Rio Grande Sul UFRGS, Postgrad Programme Epidemiol, Porto Alegre, RS, Brazil

[6] Hosp Clin Porto Alegre HCPA, Porto Alegre, RS, Brazil

[7] Univ Fed Ciencias Saude Porto Alegre UFCSPA, Porto Alegre, RS, Brazil

[8] HCor Res Inst, Sao Paulo, SP, Brazil

[9] Hosp Pronto Socorro HPS, Porto Alegre, RS, Brazil

[10] Fundacao Oswaldo Cruz FIOCRUZ, Natl Inst Infect Dis Evandro Chagas, Rio De Janeiro, RJ, Brazil

[11] Inst DOr Pesquisa & Ensino IDOR, Rio De Janeiro, RJ, Brazil

[12] Univ Fed Sao Paulo UNIFESP, Disciplina Anestesiol Dor & Med Intens, Sao Paulo, SP, Brazil

[13] Hosp Israelita Alber Einstein, Sao Paulo, SP, Brazil

[14] Univ Fed Rio Grande do Sul, Dept Stat, Porto Alegre, RS, Brazil

[15] Hosp Univ Sao Francisco Paula, Pelotas, RS, Brazil

[16] Univ Fed Pelotas UFPEL, Hosp Escola, Pelotas, RS, Brazil

[17] Hosp Univ Reg Norte Parana, Londrina, Parana, Brazil

[18] Hosp Evangel Londrina, Londrina, Parana, Brazil

[19] Hosp Reg Tarcisio Vasconcelos Maia, Mossoro, RN, Brazil

[20] Hosp Bom Jesus, Toledo, Parana, Brazil

[21] Ctr Univ Inta UNINTA, Hosp Reg Norte, Sobral, Ceara, Brazil

[22] Hosp Urgencia & Emergencia Rio Branco HUERB, Rio Branco, Acre, Brazil

[23] Hosp Base, Fac Med Sao Jose Rio Preto FAMERP, Sao Jose Do Rio Preto, SP, Brazil

[24] Hosp Geral Cleriston Andrade, Feira De Santana, BA, Brazil

[25] Hosp Restauracao, Recife, PE, Brazil

[26] Assoc Beneficente Santa Casa Campo Grande, Campo Grande, MS, Brazil

[27] Univ Fed Vale Sao Francisco HU UNIVASF, Hosp Univ, Petrolina, PE, Brazil

[28] HCPA, Intens Care, Porto Alegre, RS, Brazil

[29] Brazilian Minist Hlth, Natl Transplant Syst, Gen Coordinat Off, Esplanada Ministerios, Bloco G,Edificio Sede, Brasilia, DF, Brazil

[30] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Dept Med, Hamilton, ON, Canada

[31] Univ Fed Rio Grande do Sul, Natl Inst Hlth Technol Assessment, Porto Alegre, RS, Brazil

[32] McMaster Univ, Dept Hlth Res Methods Evidence & Impact HEI, Hamilton, ON, Canada

来源：

JAMA NETWORK OPEN | 2023年 / 6卷 / 12期

关键词：

MANAGEMENT GOALS; DECEASED-DONOR; QUALITY; DONATION; CARE; INTERVENTION; MORTALITY; PROTOCOL; NETWORK; NUMBER;

D O I：

10.1001/jamanetworkopen.2023.46901

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Importance The effectiveness of goal-directed care to reduce loss of brain-dead potential donors to cardiac arrest is unclear.Objective To evaluate the effectiveness of an evidence-based, goal-directed checklist in the clinical management of brain-dead potential donors in the intensive care unit (ICU).Design, Setting, and Participants The Donation Network to Optimize Organ Recovery Study (DONORS) was an open-label, parallel-group cluster randomized clinical trial in Brazil. Enrollment and follow-up were conducted from June 20, 2017, to November 30, 2019. Hospital ICUs that reported 10 or more brain deaths in the previous 2 years were included. Consecutive brain-dead potential donors in the ICU aged 14 to 90 years with a condition consistent with brain death after the first clinical examination were enrolled. Participants were randomized to either the intervention group or the control group. The intention-to-treat data analysis was conducted from June 15 to August 30, 2020.Interventions Hospital staff in the intervention group were instructed to administer to brain-dead potential donors in the intervention group an evidence-based checklist with 13 clinical goals and 14 corresponding actions to guide care, every 6 hours, from study enrollment to organ retrieval. The control group provided or received usual care.Main Outcomes and Measures The primary outcome was loss of brain-dead potential donors to cardiac arrest at the individual level. A prespecified sensitivity analysis assessed the effect of adherence to the checklist in the intervention group.Results Among the 1771 brain-dead potential donors screened in 63 hospitals, 1535 were included. These patients included 673 males (59.2%) and had a median (IQR) age of 51 (36.3-62.0) years. The main cause of brain injury was stroke (877 [57.1%]), followed by trauma (485 [31.6%]). Of the 63 hospitals, 31 (49.2%) were assigned to the intervention group (743 [48.4%] brain-dead potential donors) and 32 (50.8%) to the control group (792 [51.6%] brain-dead potential donors). Seventy potential donors (9.4%) at intervention hospitals and 117 (14.8%) at control hospitals met the primary outcome (risk ratio [RR], 0.70; 95% CI, 0.46-1.08; P = .11). The primary outcome rate was lower in those with adherence higher than 79.0% than in the control group (5.3% vs 14.8%; RR, 0.41; 95% CI, 0.22-0.78; P = .006).Conclusions and Relevance This cluster randomized clinical trial was inconclusive in determining whether the overall use of an evidence-based, goal-directed checklist reduced brain-dead potential donor loss to cardiac arrest. The findings suggest that use of such a checklist has limited effectiveness without adherence to the actions recommended in this checklist.

引用

页数：14

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