Time to Loss of Heartbeat After Removal of Organ Support in Non-donor Brain Dead Patients
Miriam Quinlan1, Imad Khan2, Gene Latorre3, Peter Papadakos2, Debra Roberts2, Benjamin George2, Erin Barnes1, Lily Chau1, Panayiotis Varelas1
1Neurology, Albany Medical Center, 2University of Rochester, 3SUNY Upstate Medical University
Background:
Critics of brain death allege that in the absence of diabetes insipidus (DI), brain dead (BD) patients are not dead due to implied residual hypothalamic-pituitary axis (HPA) activity.
Design/Methods:
Three NY hospitals participated in this ongoing prospective study. Non-donor adults declared BD with subsequent removal of organ support were included.
Results:
31 patients [74.2% men, 48.4% Caucasian, mean age 51.1 (range 19-74) years] met the criteria. Sixteen (51.6%) patients did not exhibit signs of DI. However, 8/16 (50%) of those were on vasopressin infusions, compared to 11/14 (78.6%) of those with DI. Extubation occurred 793 ± 745 min (range 22-3267) after BD declaration. None had respiratory effort after extubation. All patients lost pulse after 14.6 ± 4.4 min. All patients lost ECG activity after 17.7 ± 5.6 min. Ten patients were not on vasopressors at time of extubation (8 patients vasopressors were stopped 11.1 ± 6.2 min before extubation; 1 patient vasopressors were stopped 470 minutes before extubation & another was never on vasopressors). In the ten patients not on vasopressors at time of extubation, pulse was lost after 13.2 ± 3 min & ECG activity stopped after 15.6 ± 3.6 min. In patients with vasopressors stopped at time of extubation, loss of pulse occurred at 15.4 ± 4.6 min & ECG activity stopped at 19 ± 6 min (p = 0.18 & 0.11, respectively). There was no difference in time to loss of pulse or cessation of ECG activity between those with & without DI (p = 0.27 & 0.12, respectively).
Conclusions:
The average time to loss of pulse post-extubation was 15 minutes. This time shortened when vasopressors were stopped before extubation. There was a correlation between SBP before extubation and time to loss of arterial pulsation, indicating possibility of residual circulating vasopressor effect. DI did not play any role in maintaining pulse or ECG activity.
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