Prediction of potential for organ donation after cardiac death in patients in neurocritical state: a prospective observational study

AA Rabinstein, AH Yee, J Mandrekar, JE Fugate, Yorick Groot, Erwin Kompanje, LA Shutter, WD Freeman, MA Rubin, EFM Wijdicks

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Abstract

Background Successful donation of organs after cardiac death (DCD) requires identification of patients who will die within 60 mm of withdrawal of life-sustaining treatment (WLST). We aimed to validate a straightforward model to predict the likelihood of death within 60 min of WLST in patients with irreversible brain injury. Methods In this multicentre, observational study, we prospectively enrolled consecutive comatose patients with irreversible brain injury undergoing WLST at six medical centres in the USA and the Netherlands. We assessed four clinical characteristics (corneal reflex, cough reflex, best motor response, and oxygenation index) as predictor variables, which were selected on the basis of previous findings. We excluded patients who had brain death or were not intubated. The primary endpoint was death w Findings We included 178 patients, 82 (46%) of whom died within 60 mm of WLST. Absent corneal reflexes (odds ratio [OR] 2.67, 95% CI 1.19-6.01; p=0.0173; 1 point), absent cough reflex (4.16, 1.79-9.70; p=0.0009; 2 points), extensor or absent motor responses (2.99, 1.22-7.34; p=0.0168; 1 point), and an oxygenation index score of more than 3.0 (2.31, 1.10-4.88; p=0.0276; 1 point) were predictive of death within 60 mm of WLST. 59 of 82 patients who died within 60 min of WLST had DCD-N scores of 3 o Interpretation The DCD-N score can be used to predict potential candidates for DCD in patients with non-survivable brain injury. However, this score needs to be tested specifically in a cohort of potential donors participating in DCD protocols.
Original languageUndefined/Unknown
Pages (from-to)414-419
Number of pages6
JournalLancet Neurology
Volume11
Issue number5
DOIs
Publication statusPublished - 2012

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