Abstract Details

Title Time to Loss of Heartbeat After Removal of Organ Support in Non-donor Brain Dead Patients

Topic Neuro Trauma and Critical Care

Presentation(s) P7 - Poster Session 7 (5:00 PM-6:00 PM)

Poster/Presentation
Number 7-004

Objective NA

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.

Authors/Disclosures
Miriam Quinlan, MD, MPH PRESENTER	Dr. Quinlan has nothing to disclose.
Imad R. Khan, MD (University of Rochester Medical Center)	The institution of Dr. Khan has received research support from National Institute of Neurological Diseases and Stroke. The institution of Dr. Khan has received research support from National Heart Lung and Blood Institute. The institution of Dr. Khan has received research support from National Institute of Neurological Diseases and Stroke.
Julius Latorre, MD, FAAN (SUNY Upstate Med Univ Hosp/Neuro)	Dr. Latorre has nothing to disclose.
Peter J. Papadakos, MD	Dr. Papadakos has received publishing royalties from a publication relating to health care. Dr. Papadakos has received publishing royalties from a publication relating to health care.
Debra Roberts, MD, PhD (University of Rochester Medical Center)	Dr. Roberts has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Buckland Law Firm.
Benjamin P. George, MD (U of Rochester, Dept of Neurology)	Dr. George has nothing to disclose.
Erin Barnes, MD (Albany Medical Center)	An immediate family member of Dr. Barnes has received personal compensation for serving as an employee of Go2For Lung Cancer. The institution of Dr. Barnes has received research support from NIH.
Lily Chau, MD (SUNY Downstate Medical Center)	Dr. Chau has nothing to disclose.
Panayiotis N. Varelas, MD, PhD, FAAN (Albany Med-Department of Neurology)	Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Astra Zeneca -Alexion - Portola. Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Annexon. Dr. Varelas has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Astra Zeneca- Alexion-Portola. Dr. Varelas has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Marinus. Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Annexon. Dr. Varelas has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Giammarco, Mullins & Horton P.C. The institution of Dr. Varelas has received research support from Marinus. The institution of Dr. Varelas has received research support from Bayer. Dr. Varelas has received publishing royalties from a publication relating to health care. An immediate family member of Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving as a Rep to the RUC meeting with AAN. Dr. Varelas has received personal compensation in the range of $500-$4,999 for serving as a Speaker at the Annual Meeting with AAN. Dr. Varelas has a non-compensated relationship as a President - Past President with Neurocritical Care Society that is relevant to AAN interests or activities.

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