Resumption of Cardiac Activity after Withdrawal of Life-Sustaining Measures

被引：79

作者：

Dhanani, S. ^{[1
,2
,3
]}

Hornby, L. ^{[2
,5
]}

van Beinum, A. ^{[2
,6
]}

Scales, N. B. ^{[7
,8
]}

Hogue, M. ^{[2
]}

Baker, A. ^{[14
]}

Beed, S. ^{[20
,21
]}

Boyd, J. G. ^{[22
,23
]}

Chandler, J. A. ^{[4
]}

Chasse, M. ^{[24
]}

D'Aragon, F. ^{[29
,30
]}

Dezfulian, C. ^{[49
]}

Doig, C. J. ^{[31
,32
,33
,36
]}

Duska, F. ^{[50
,51
]}

Friedrich, J. O. ^{[15
,16
]}

Gardiner, D. ^{[54
,55
]}

Gofton, T. ^{[37
,38
]}

Harvey, D. ^{[54
,55
]}

Herry, C. ^{[7
,8
]}

Isac, G. ^{[42
,43
]}

Kramer, A. H. ^{[34
,35
]}

Kutsogiannis, D. J. ^{[44
]}

Maslove, D. M. ^{[22
,23
]}

Meade, M. ^{[45
,46
]}

Mehta, S. ^{[17
,18
]}

Munshi, L. ^{[18
]}

Norton, L. ^{[39
]}

Pagliarello, G. ^{[10
]}

Ramsay, T. ^{[9
]}

Rusinova, K. ^{[52
,53
]}

Scales, D. ^{[15
,18
]}

Schmidt, M. ^{[50
,51
]}

Seely, A. ^{[7
,8
,11
,12
]}

Shahin, J. ^{[25
,26
]}

Slessarev, M. ^{[40
,41
]}

So, D. ^{[13
]}

Talbot, H. ^{[2
,19
]}

van Mook, W. N. K. A. ^{[56
]}

Waldauf, P. ^{[50
,51
]}

Weiss, M. ^{[27
,47
,48
]}

Wind, J. T. ^{[57
]}

Shemie, S. D. ^{[5
,26
,28
]}

机构：

[1] Univ Ottawa, Childrens Hosp Eastern Ontario, Ottawa, ON, Canada

[2] Univ Ottawa, Childrens Hosp Eastern Ontario Res Inst, Ottawa, ON, Canada

[3] Univ Ottawa, Fac Med, Ottawa, ON, Canada

[4] Univ Ottawa, Ctr Hlth Law Policy & Eth, Ottawa, ON, Canada

[5] Canadian Blood Serv, Ottawa, ON, Canada

[6] Carleton Univ, Ottawa, ON, Canada

[7] Ottawa Hosp Res Inst, Dynam Anal Lab, Ottawa, ON, Canada

[8] Ottawa Hosp Res Inst, Clin Epidemiol Program, Ottawa, ON, Canada

[9] Ottawa Hosp Res Inst, Clin Epidemiol Program Methods Ctr, Ottawa, ON, Canada

[10] Ottawa Hosp, Dept Crit Care & Gen Surg, Ottawa, ON, Canada

[11] Ottawa Hosp, Dept Surg, Ottawa, ON, Canada

[12] Ottawa Hosp, Div Thorac Surg, Ottawa, ON, Canada

[13] Univ Ottawa Heart Inst, Intervent Cardiol Program, Ottawa, ON, Canada

[14] St Michaels Hosp, Dept Crit Care Trauma & Neurosurg Program, Toronto, ON, Canada

[15] Unity Hlth St Michaels Hosp, Li Ka Shing Knowledge Inst, Toronto, ON, Canada

[16] Univ Toronto, Toronto, ON, Canada

[17] Univ Toronto, Mt Sinai Hosp, Toronto, ON, Canada

[18] Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada

[19] Canadian Donat & Transplantat Res Program, Toronto, ON, Canada

[20] Dalhousie Univ, Dept Crit Care, Halifax, NS, Canada

[21] Dalhousie Univ, Dept Anesthesia, Halifax, NS, Canada

[22] Queens Univ, Dept Med, Kingston, ON, Canada

[23] Queens Univ, Dept Crit Care Med, Kingston, ON, Canada

[24] Univ Montreal Hosp, Res Ctr, Dept Med Crit Care, Montreal, PQ, Canada

[25] McGill Univ, Div Pulm Med, Dept Crit Care, Montreal, PQ, Canada

[26] McGill Univ Hlth Ctr & Res Inst, Montreal, PQ, Canada

[27] Transplant Quebec, Montreal, PQ, Canada

[28] Montreal Childrens Hosp, Div Crit Care, Montreal, PQ, Canada

[29] Univ Sherbrooke, Dept Anesthesiol, Sherbrooke, PQ, Canada

[30] Ctr Hosp Univ CHU Sherbrooke, Ctr Rech, Sherbrooke, PQ, Canada

[31] Univ Calgary, Cumming Sch Med, Dept Crit Care Med, Calgary, AB, Canada

[32] Univ Calgary, Cumming Sch Med, Dept Community Hlth Sci, Calgary, AB, Canada

[33] Univ Calgary, Cumming Sch Med, Dept Med, Calgary, AB, Canada

[34] Univ Calgary, Dept Crit Care Med, Calgary, AB, Canada

[35] Univ Calgary, Dept Clin Neurosci, Calgary, AB, Canada

[36] Alberta Hlth Serv, Calgary Zone, Calgary, AB, Canada

[37] Western Univ, Dept Clin Neurol Sci, London Hlth Sci Ctr, London, ON, Canada

[38] Western Univ, Schulich Sch Med & Dent, London, ON, Canada

[39] Western Univ, Kings Univ Coll, Dept Psychol, London, ON, Canada

[40] Western Univ, Dept Med, London, ON, Canada

[41] Western Univ, Brain & Mind Inst, London, ON, Canada

[42] Univ British Columbia, Dept Med, Div Crit Care, Vancouver, BC, Canada

[43] Univ British Columbia, Dept Anesthesia, Div Crit Care, Vancouver, BC, Canada

[44] Univ Alberta, Fac Med & Dent, Dept Crit Care Med, Edmonton, AB, Canada

[45] McMaster Univ, Dept Med, Hamilton, ON, Canada

[46] Hamilton Hlth Sci Ctr, Hamilton, ON, Canada

[47] CHU Quebec, Ctr Mere Enfant Soleil, Div Pediat Intens Care, Quebec City, PQ, Canada

[48] Univ Laval, Fac Med, Dept Pediat, Quebec City, PQ, Canada

[49] Univ Pittsburgh, Sch Med, Crit Care Med Dept, Safar Ctr Resuscitat Res, Pittsburgh, PA USA

[50] Charles Univ Prague, Fac Med 3, Prague, Czech Republic

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2021年 / 384卷 / 04期

关键词：

DONATION; AUTORESUSCITATION; TRANSPLANTATION; DEATH;

D O I：

10.1056/NEJMoa2022713

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND The minimum duration of pulselessness required before organ donation after circulatory determination of death has not been well studied. METHODS We conducted a prospective observational study of the incidence and timing of resumption of cardiac electrical and pulsatile activity in adults who died after planned withdrawal of life-sustaining measures in 20 intensive care units in three countries. Patients were intended to be monitored for 30 minutes after determination of death. Clinicians at the bedside reported resumption of cardiac activity prospectively. Continuous blood-pressure and electrocardiographic (ECG) wave-forms were recorded and reviewed retrospectively to confirm bedside observations and to determine whether there were additional instances of resumption of cardiac activity. RESULTS A total of 1999 patients were screened, and 631 were included in the study. Clinically reported resumption of cardiac activity, respiratory movement, or both that was confirmed by waveform analysis occurred in 5 patients (1%). Retrospective analysis of ECG and blood-pressure waveforms from 480 patients identified 67 instances (14%) with resumption of cardiac activity after a period of pulselessness, including the 5 reported by bedside clinicians. The longest duration after pulselessness before resumption of cardiac activity was 4 minutes 20 seconds. The last QRS complex coincided with the last arterial pulse in 19% of the patients. CONCLUSIONS After withdrawal of life-sustaining measures, transient resumption of at least one cycle of cardiac activity after pulselessness occurred in 14% of patients according to retrospective analysis of waveforms; only 1% of such resumptions were identified at the bedside. These events occurred within 4 minutes 20 seconds after a period of pulselessness. (Funded by the Canadian Institutes for Health Research and others.)

引用

页码：345 / 352

页数：8

共 23 条

[1] Approximate is better than "exact" for interval estimation of binomial proportions
Agresti, A
Coull, BA
[J]. AMERICAN STATISTICIAN, 1998, 52 (02) : 119 - 126
[2] The boundaries of organ donation after circulatory death
Bernat, James L.
[J]. NEW ENGLAND JOURNAL OF MEDICINE, 2008, 359 (07) : 669 - 671
[3] Pediatric heart transplantation after declaration of cardiocirculatory death
Boucek, Mark M.
Mashburn, Christine
Dunn, Susan M.
Frizell, Rebecca
Edwards, Leah
Pietra, Biagio
Campbell, David
[J]. NEW ENGLAND JOURNAL OF MEDICINE, 2008, 359 (07) : 709 - 714
[4] Review and classification of variability analysis techniques with clinical applications
Bravi, Andrea
Longtin, Andre
Seely, Andrew J. E.
[J]. BIOMEDICAL ENGINEERING ONLINE, 2011, 10
[5] The use of confidence or fiducial limits illustrated in the case of the binomial.
Clopper, CJ
Pearson, ES
[J]. BIOMETRIKA, 1934, 26 : 404 - 413
[6] Audit of ten years of donation after circulatory death experience in Queensland: observations of agonal physiology following withdrawal of cardiorespiratory support
Cook, D. A.
Widdicombe, N.
[J]. ANAESTHESIA AND INTENSIVE CARE, 2018, 46 (04) : 400 - 403
[7] Cardiac transplantation in infants
Curfman, Gregory D.
Morrissey, Stephen
Drazen, Jeffrey M.
[J]. NEW ENGLAND JOURNAL OF MEDICINE, 2008, 359 (07) : 749 - 750
[8] Vital Signs After Cardiac Arrest Following Withdrawal of Life-Sustaining Therapy: A Multicenter Prospective Observational Study
Dhanani, Sonny
Hornby, Laura
Ward, Roxanne
Baker, Andrew
Dodek, Peter
Chamber-Evans, Jane
Fowler, Rob
Friedrich, Jan O.
Gow, Robert M.
Kutsogiannis, Demetrios J.
Mcintyre, Lauralyn
Momoli, Franco
Morin, Karine
Ramsay, Tim
Scales, Damon
Writer, Hilary
Yildirim, Serafettin
Young, Bryan
Shemie, Sam
[J]. CRITICAL CARE MEDICINE, 2014, 42 (11) : 2358 - 2369
[9] Dhanani Sonny, 2012, J Intensive Care Med, V27, P238, DOI 10.1177/0885066610396993
[10] Greer DM, 2020, JAMA

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