Cerebral cortical activity after withdrawal of life-sustaining measures in critically ill patients.

Autor: Gofton TE; Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.; Western Institute for Neuroscience, Western University, London, Ontario, Canada., Norton L; Department of Psychology, King's University College at Western University, London, Ontario, Canada., Laforge G; Western Institute for Neuroscience, Western University, London, Ontario, Canada., Gibson R; Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada., Debicki D; Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.; Western Institute for Neuroscience, Western University, London, Ontario, Canada., Althenayan E; Department of Medicine/Critical Care, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada., Scales N; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada., Beinum AV; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada., Hornby L; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.; Canadian Blood Services, Ottawa, Ontario, Canada., Shemie S; Canadian Blood Services, Ottawa, Ontario, Canada.; Pediatric Intensive Care, McGill University Health Centre & Research Institute, Montreal, Quebec, Canada., Dhanani S; Pediatric Critical Care, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada., Slessarev M; Department of Psychology, King's University College at Western University, London, Ontario, Canada.; Department of Medicine/Critical Care, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Jazyk: angličtina
Zdroj: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2022 Dec; Vol. 22 (12), pp. 3120-3129. Date of Electronic Publication: 2022 Jul 23.
DOI: 10.1111/ajt.17146
Abstrakt: Establishing when cerebral cortical activity stops relative to circulatory arrest during the dying process will enhance trust in donation after circulatory determination of death. We used continuous electroencephalography and arterial blood pressure monitoring prior to withdrawal of life sustaining measures and for 30 min following circulatory arrest to explore the temporal relationship between cessation of cerebral cortical activity and circulatory arrest. Qualitative and quantitative EEG analyses were completed. Among 140 screened patients, 52 were eligible, 15 were enrolled, 11 completed the full study, and 8 (3 female, median age 68 years) were included in the analysis. Across participants, EEG activity stopped at a median of 78 (Q1 = -387, Q3 = 111) seconds before circulatory arrest. Following withdrawal of life sustaining measures there was a progressive reduction in electroencephalographic amplitude (p = .002), spectral power (p = .008), and coherence (p = .003). Prospective recording of cerebral cortical activity in imminently dying patients is feasible. Our results from this small cohort suggest that cerebral cortical activity does not persist after circulatory arrest. Confirmation of these findings in a larger multicenter study are needed to help promote stakeholder trust in donation after circulatory determination of death.
(© 2022 The American Society of Transplantation and the American Society of Transplant Surgeons.)
Databáze: MEDLINE
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