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dc.contributor.authorGardiner, Dale C.
dc.date.accessioned2023-06-05T13:42:01Z
dc.date.available2023-06-05T13:42:01Z
dc.date.issued2021
dc.identifier.citationDhanani, S., Hornby, L., van Beinum, A., Scales, N.B., Hogue, M., Baker, A., Beed, S., Boyd, J.G., Chandler, J.A., Chasse, M., D'Aragon, F., Dezfulian, C., Doig, C.J., Duska, F., Friedrich, J.O., Gardiner, D.C., Gofton, T., Harvey, D., Herry, C., Isac, G., Kramer, A.H., Kutsogiannis, D.J., Maslove, D.M., Meade, M., Mehta, S., Munshi, L., Norton, L., Pagliarello, G., Ramsay, T., Rusinova, K., Scales, D., Schmidt, M., Seely, A., Shahin, J., Slessarev, M., So, D., Talbot, H., van Mook, Walther N K A., Waldauf, P., Weiss, M., Wind, J.T. and Shemie, S.D. (2021) 'Resumption of cardiac activity after withdrawal of life-sustaining measures', New England Journal of Medicine, 384(4), pp. 345-352. doi: 10.1056/NEJMoa2022713.en_US
dc.identifier.issn1533-4406
dc.identifier.urihttp://hdl.handle.net/20.500.12904/17140
dc.descriptionAvailable to read on the publisher's website here: https://www.nejm.org/doi/full/10.1056/NEJMoa2022713. For personal use only.en_US
dc.description.abstractBACKGROUND: 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) waveforms 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.). Copyright © 2021 Massachusetts Medical Society.
dc.description.urihttps://www.nejm.org/doi/full/10.1056/NEJMoa2022713en_US
dc.language.isoenen_US
dc.subjectCirculatory deathen_US
dc.subjectDeathen_US
dc.subjectOrgan donationen_US
dc.titleResumption of cardiac activity after withdrawal of life-sustaining measuresen_US
dc.typeArticleen_US
rioxxterms.funderDefault funderen_US
rioxxterms.identifier.projectDefault projecten_US
rioxxterms.versionVoRen_US
rioxxterms.versionofrecord10.1056/NEJMoa2022713en_US
rioxxterms.typeJournal Article/Reviewen_US
refterms.dateFCD2023-06-05T13:42:03Z
refterms.versionFCDVoR
refterms.panelUnspecifieden_US
html.description.abstractBACKGROUND: 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) waveforms 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.). Copyright © 2021 Massachusetts Medical Society.en_US
rioxxterms.funder.project94a427429a5bcfef7dd04c33360d80cden_US


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