Vital signs after cardiac arrest following withdrawal of life-sustaining therapy: a multicenter prospective observational study

Sonny Dhanani; Laura Hornby; Roxanne Ward; Andrew Baker; Peter Dodek; Jane Chamber-Evans; Rob Fowler; Jan O Friedrich; Robert M Gow; Demetrios J Kutsogiannis; Lauralyn Mcintyre; Franco Momoli; Karine Morin; Tim Ramsay; Damon Scales; Hilary Writer; Serafettin Yildirim; Bryan Young; Sam Shemie; Canadian Critical Care Trials Group and in collaboration with the Bertram Loeb Chair and Research Consortium in Organ and Tissue Donation

doi:10.1097/CCM.0000000000000417

Vital signs after cardiac arrest following withdrawal of life-sustaining therapy: a multicenter prospective observational study

Crit Care Med. 2014 Nov;42(11):2358-69. doi: 10.1097/CCM.0000000000000417.

Affiliation

¹ 1Division of Pediatric Critical Care, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. 2Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada. 3Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. 4Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada. 5McGill University Health Centre Research Institute, Montreal, QC, Canada. 6Department of Critical Care, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada. 7Faculty of Medicine, Interdepartmental Division of Critical Care, University of Toronto, ON, Canada. 8Critical Care Medicine and Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada. 9Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. 10Ingram School of Nursing McGill University, McGill University Health Centre, Montreal, QC, Canada. 11Faculty of Medicine Biomedical Ethics Unit, McGill University, Montreal, QC, Canada. 12Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 13Pediatric Cardiology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. 14Neurosciences Intensive Care Unit, University of Alberta Hospital, Edmonton, AB, Canada. 15Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada. 16Critical Care, The Ottawa Hospital, Ottawa, ON, Canada. 17Department of Medicine, University of Ottawa, Ottawa, ON, Canada. 18The Ottawa Health Research Institute, Ottawa, ON, Canada. 19The Clinical Epidemiology Program Methods Centre, University of Ottawa, Ottawa, ON, Canada. 20Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON, Canada. 21National GE3LS Program, Genome Canada, Ottawa, ON, Canada. 22Information Systems, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. 23Department of Clinical Neurological Sciences, London Health Scien

PMID: 24810533
DOI: 10.1097/CCM.0000000000000417

Abstract

Objective: Controversies regarding the process and timing of the determination of death for controlled organ donation after circulatory death persist. This study assessed the feasibility of conducting a prospective, observational study of continuous monitoring of vital signs for 30 minutes after the clinical determination of death in five Canadian ICUs. Waveform data were analyzed.

Design: Prospective observational cohort study.

Setting: One pediatric and four adult Canadian ICUs.

Patients: One month of age or older, admitted to the ICU, and for whom a consensual decision to withdraw life-sustaining therapies had been made, with an anticipation of imminent death.

Interventions: None.

Measurements and main results: Invasive arterial blood pressure, electrocardiogram, and oxygen saturation plethysmography activity were recorded and reviewed for 30 minutes after declaration of death. Feasibility was assessed (recruitment, consent rate, protocol compliance, and staff satisfaction). Of 188 subjects screened over 16 months, 41 subjects were enrolled (87% consent rate). Data collection was complete for 30 subjects (73% protocol compliance). In four subjects, arterial blood pressure resumed following cessation of activity. The longest period of cessation of arterial blood pressure before resumption was 89 seconds. The duration of resumed activity ranged from 1 to 172 seconds. No cases of sustained resumption of arterial blood pressure activity were recorded, and no instances of clinical autoresuscitation were reported. In nearly all patients (27 of 30), electrocardiogram activity continued after the disappearance of arterial blood pressure.

Conclusions: This is the first observational study to prospectively collect waveform data for 30 minutes after the declaration of death. A future larger study may support initial data suggesting that circulatory function does not resume after more than 89 seconds of absence. Furthermore, persistence of cardiac electrical activity with the documented absence of circulation may not be relevant to declaration of death.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Advanced Cardiac Life Support / methods*
Canada
Cardiopulmonary Resuscitation / methods
Child
Child, Preschool
Cohort Studies
Death
Feasibility Studies
Female
Heart Arrest / mortality*
Heart Arrest / therapy*
Humans
Infant
Infant, Newborn
Intensive Care Units
Male
Pilot Projects
Prospective Studies
Quality Control
Time Factors
Tissue and Organ Procurement / organization & administration*
Vital Signs / physiology*
Withholding Treatment*

Grants and funding

Canadian Institutes of Health Research/Canada