Intensive care practices in brain death diagnosis and organ donation

被引：61

作者：

Escudero, D. ^{[1
]}

Valentin, M. O. ^{[4
]}

Escalante, J. L. ^{[5
]}

Sanmartin, A. ^{[7
]}

Perez-Basterrechea, M. ^{[3
]}

de Gea, J. ^{[7
]}

Martin, M. ^{[2
]}

Velasco, J. ^{[8
]}

Pont, T. ^{[9
]}

Masnou, N. ^{[9
]}

de la Calle, B. ^{[6
]}

Marcelo, B. ^{[10
]}

Lebron, M. ^{[11
]}

Perez, J. M. ^{[12
]}

Burgos, M. ^{[12
]}

Gimeno, R. ^{[13
]}

Kot, P. ^{[14
]}

Yus, S. ^{[14
]}

Sancho, I. ^{[15
]}

Zabalegui, A. ^{[16
]}

Arroyo, M. ^{[16
]}

Minambres, E. ^{[17
]}

Elizalde, J. ^{[18
]}

Montejo, J. C. ^{[19
]}

Dominguez-Gil, B. ^{[4
]}

Matesanz, R. ^{[4
]}

机构：

[1] Cent Univ Hosp Asturias, Dept, Oviedo, Spain

[2] Cent Univ Hosp Asturias, Intens Care Unit, Oviedo, Spain

[3] Cent Univ Hosp Asturias, Unit Transplants Cell Therapy & Regenerat Med, Oviedo, Spain

[4] Spanish Natl Transplant Org ONT, Madrid, Spain

[5] Gregorio Maran Univ Hosp, Hosp Transplant Program, Madrid, Spain

[6] Gregorio Maran Univ Hosp, Intens Care Unit, Madrid, Spain

[7] Virgen Arrixaca Hosp, Intens Care Unit, Murcia, Spain

[8] Son Espases Univ Hosp, Intens Care Unit, Palma de Mallorca, Spain

[9] Vall Hebron Hosp, Intens Care Unit, Barcelona, Spain

[10] Infanta Cristina Univ Hosp, Intens Care Unit, Badajoz, Spain

[11] Carlos Haya Hosp, Intens Care Unit, Malaga, Spain

[12] Virgen Nieves Univ Hosp, Intens Care Unit, Granada, Spain

[13] La Fe Univ Hosp, Intens Care Unit, Valencia, Spain

[14] La Paz Univ Hosp, Intens Care Unit, Madrid, Spain

[15] Miguel Servet Univ Hosp, Intens Care Unit, Zaragoza, Spain

[16] Gen Yague Hosp, Intens Care Unit, Burgos, Spain

[17] Marques Valdecilla Univ Hosp, Intens Care Unit, Santander, Spain

[18] Asistential Complex Navarra, Intens Care Unit, Pamplona, Spain

[19] 12 Octubre Univ Hosp, Intens Care Unit, Dept, Madrid, Spain

来源：

ANAESTHESIA | 2015年 / 70卷 / 10期

关键词：

DONORS; VARIABILITY; PERFORMANCE; HEMORRHAGE; MANAGEMENT; STROKE; SCALE; SCORE; TIME;

D O I：

10.1111/anae.13065

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

We conducted a multicentre study of 1844 patients from 42 Spanish intensive care units, and analysed the clinical characteristics of brain death, the use of ancillary testing, and the clinical decisions taken after the diagnosis of brain death. The main cause of brain death was intracerebral haemorrhage (769/1844, 42%), followed by traumatic brain injury (343/1844, 19%) and subarachnoid haemorrhage (257/1844, 14%). The diagnosis of brain death was made rapidly (50% in the first 24 h). Of those patients who went on to die, the Glasgow Coma Scale on admission was >= 8/15 in 1146/1261 (91%) of patients with intracerebral haemorrhage, traumatic brain injury or anoxic encephalopathy; the Hunt and Hess Scale was 4-5 in 207/251 (83%) of patients following subarachnoid haemorrhage; and the National Institutes of Health Stroke Scale was >= 15 in 114/129 (89%) of patients with strokes. Brain death was diagnosed exclusively by clinical examination in 92/1844 (5%) of cases. Electroencephalography was the most frequently used ancillary test (1303/1752, 70.7%), followed by transcranial Doppler (652/1752, 37%). Organ donation took place in 70% of patients (1291/1844), with medical unsuitability (267/553, 48%) and family refusal (244/553, 13%) the main reasons for loss of potential donors. All life-sustaining measures were withdrawn in 413/553 of non-donors (75%).

引用

页码：1130 / 1139

页数：10

共 45 条

[1] Baseline NIH Stroke Scale score strongly predicts outcome after stroke - A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST) [J].

Adams, HP ;

Davis, PH ;

Leira, EC ;

Chang, KC ;

Bendixen, BH ;

Clarke, WR ;

Woolson, RF ;

Hansen, MD .

NEUROLOGY, 1999, 53 (01) :126-131

[2]

[Anonymous], PEOPL KILL ROAD ACC

[3]

[Anonymous], 1968, JAMA, V205, P85

[4]

[Anonymous], 1995, NEUROLOGY

[5] Potential for organ donation in the United Kingdom: audit of intensive care records [J].

Barber, Kerri ;

Falvey, Sue ;

Hamilton, Claire ;

Collett, Dave ;

Rudge, Chris .

BMJ-BRITISH MEDICAL JOURNAL, 2006, 332 (7550) :1124-1126A

[6] Brainstem death testing in the UK - time for reappraisal? [J].

Bell, MDD ;

Moss, E ;

Murphy, PG .

BRITISH JOURNAL OF ANAESTHESIA, 2004, 92 (05) :633-640

[7] How can we achieve uniformity in brain death determinations? [J].

Bernat, James L. .

NEUROLOGY, 2008, 70 (04) :252-253

[8] VOLUME OF INTRACEREBRAL HEMORRHAGE - A POWERFUL AND EASY-TO-USE PREDICTOR OF 30-DAY MORTALITY [J].

BRODERICK, JP ;

BROTT, TG ;

DULDNER, JE ;

TOMSICK, T ;

HUSTER, G .

STROKE, 1993, 24 (07) :987-993

[9] Imminent brain death: point of departure for potential heart-beating organ donor recognition [J].

de Groot, Yorick J. ;

Jansen, Nichon E. ;

Bakker, Jan ;

Kuiper, Michael A. ;

Aerdts, Stan ;

Maas, Andrew I. R. ;

Wijdicks, Eelco F. M. ;

van Leiden, Hendrik A. ;

Hoitsma, Andries J. ;

Kremer, Berry H. P. H. ;

Kompanje, Erwin J. O. .

INTENSIVE CARE MEDICINE, 2010, 36 (09) :1488-1494

[10] Continuously Evaluating Performance in Deceased Donation: The Spanish Quality Assurance Program [J].

de la Rosa, G. ;

Dominguez-Gil, B. ;

Matesanz, R. ;

Ramon, S. ;

Alonso-Alvarez, J. ;

Araiz, J. ;

Choperena, G. ;

Cortes, J. L. ;

Daga, D. ;

Elizalde, J. ;

Escudero, D. ;

Escudero, E. ;

Fernandez-Renedo, C. ;

Frutos, M. A. ;

Galan, J. ;

Getino, M. A. ;

Guerrero, F. ;

Lara, M. ;

Lopez-Sanchez, L. ;

Macias, S. ;

Martinez-Guillen, J. ;

Masnou, N. ;

Pedraza, S. ;

Pont, T. ;

Sanchez-Rodriguez, A. .

AMERICAN JOURNAL OF TRANSPLANTATION, 2012, 12 (09) :2507-2513

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