Determination of death after circulatory arrest by intensive care physicians: A survey of current practice in the Netherlands

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• 作者：Jentina Wind ; Msc^a ; ^{t.wind@mumc.nl" class="auth_mail" title="E-mail the corresponding author} ; Walther N.K.A. van Mook ; MD ; PhD^b ; Sonny Dhanani ; MD^c ; Ernest W.L. van Heurn ; MD ; PhD^a
• 关键词：Determination of death ; Circulatory death ; Cardiac arrest ; Autoresuscitation ; Organ donation ; Intensive care
• 刊名：Journal of Critical Care
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：31
• 期：1
• 页码：2-6
• 全文大小：273 K

文摘

Determination of death is an essential part of donation after circulatory death (DCD). We studied the current practices of determination of death after circulatory arrest by intensive care physicians in the Netherlands, the availability of guidelines, and the occurrence of the phenomenon of autoresuscitation.

Methods

The Determination of Cardiac Death Practices in Intensive Care Survey was sent to all intensive care physicians.

Results

Fifty-five percent of 568 Dutch intensive care physicians responded. Most respondents learned death determination from clinical practice. The most commonly used tests for death determination were flat arterial line tracing, flat electrocardiogram (standard 3-lead electrocardiogram), and fixed and dilated pupils. Rarely used tests were absence pulse by echo Doppler, absent blood pressure by noninvasive monitoring, and unresponsiveness to painful stimulus. No diagnostic test or procedure was uniformly performed, but 80% of respondents perceived a need for standardization of death determination. Autoresuscitation was witnessed by 37%, after withdrawal of treatment or after unsuccessful resuscitation.

Conclusions

Extensive variability in the practice of determining death after circulatory arrest exists, and a need for guidelines and standardization, especially if organ donation follows death, is reported. Autoresuscitation is reported; this observation requires attention in further prospective observational studies.