Development of the University of Wisconsin Donation after Cardiac Death Evaluation Tool

Lewis, John W.; Peltier, James W.; Nelson, Helen M.; Snyder, William H.; Schneider, Kristi; Steinberger, Dina; Anderson, Michael E.; Krichevsky, Alexander; Anderson, John M.; Ellefson, Jill; D’Alessandro, Anthony M.

doi:10.1177/152692480301300405

Cited by 112 publications

(65 citation statements)

References 15 publications

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“…The majority of studies evaluating time to death after withdrawal of life-sustaining measures have assessed time to death as a dichotomous outcome (death within 60 minutes versus death occurring after this time). [6][7][8][9][10][11][12]15,16 Utilization of time to death in a continuous fashion may better identify independent predictors of time to death after withdrawal of life-sustaining measures. Improved predictive capability may enhance communication with family members about the dying process and thus improve end-of-life care for patients and their family members.…”

mentioning

confidence: 99%

Time to Death after Terminal Withdrawal of Mechanical Ventilation: Specific Respiratory and Physiologic Parameters May Inform Physician Predictions

Long

Muni

Treece

et al. 2015

Journal of Palliative Medicine

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Background: Discussions about withdrawal of life-sustaining therapies often include family members of critically ill patients. These conversations should address essential components of the dying process, including expected time to death after withdrawal. Objectives: The study objective was to aid physician communication about the dying process by identifying predictors of time to death after terminal withdrawal of mechanical ventilation. Methods: We conducted an observational analysis from a single-center, before-after evaluation of an intervention to improve palliative care. We studied 330 patients who died after terminal withdrawal of mechanical ventilation. Predictors included patient demographics, laboratory, respiratory, and physiologic variables, and medication use. Results: The median time to death for the entire cohort was 0.58 hours (interquartile range (IQR) 0.22-2.25 hours) after withdrawal of mechanical ventilation. Using Cox regression, independent predictors of shorter time to death included higher positive end-expiratory pressure (per 1 cm H 2 O hazard ratio [HR], 1.07; 95% CI 1.04-1.11); higher static pressure (per 1 cm H 2 O HR, 1.03; 95% CI 1.01-1.04); extubation prior to death (HR, 1.41; 95% CI 1.06-1.86); and presence of diabetes (HR, 1.75; 95% CI 1.25-2.44). Higher noninvasive mean arterial pressure predicted longer time to death (per 1 mmHg HR, 0.98; 95% CI 0.97-0.99). Conclusions: Comorbid illness and key respiratory and physiologic parameters may inform physician predictions of time to death after withdrawal of mechanical ventilation. An understanding of the predictors of time to death may facilitate discussions with family members of dying patients and improve communication about end-of-life care.

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mentioning

confidence: 99%

Time to Death after Terminal Withdrawal of Mechanical Ventilation: Specific Respiratory and Physiologic Parameters May Inform Physician Predictions

Long

Muni

Treece

et al. 2015

Journal of Palliative Medicine

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“…23 The tool may be used to: • Determine eligibility to donate • Provide input to family discussions about likelihood for successful donation • Guide the preferred location for WLST.…”

Section: Estimation Of Time To Death After Wlstmentioning

confidence: 99%

“…23 The testing protocol requires the collection of information that includes patient age, airway status, vasopressor and inotrope therapy, and the respiratory status following 10 minutes of disconnect from the ventilator (respiratory rate, tidal volume, negative inspiratory force, blood pressure, pulse and oxygen saturation). Selection of candidates for organ donation is based on the respiratory drive assessment and the use of this predictive tool before WLST.…”

Section: Predicting Deathmentioning

confidence: 99%

Donation after cardiocirculatory death in Canada

Shemie¹,

Baker²,

Knoll³

et al. 2006

Canadian Medical Association Journal

211

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“…36 The University of Wisconsin developed a protocol and an evaluation tool to determine the eligibility of potential candidates for NHBOD. 44 The protocol entails temporary discontinuation of mechanical ventilation for a trial of spontaneous respiration lasting up to 10 minutes to determine the likelihood of cardiorespiratory death within 60-90 minutes of the withdrawal of life support. Those patients predicted by the University of Wisconsin evaluation tool to survive a longer time are not candidates for NHBOD and are transferred to palliative care.…”

Section: Table 3 Domains Of Quality Indicators Of End-of-life Care Anmentioning

confidence: 99%

“Non‐heart‐beating,” or “cardiac death,” organ donation: Why we should care

Rady

Verheijde

McGregor

2007

Journal of Hospital Medicine

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BACKGROUNDOrgan donation after cessation of cardiac pump activity is referred to as non‐heart‐beating organ donation (NHBOD). NHBOD donors can be neurologically intact; they do not fulfill the brain death criteria prior to cessation of cardiac pump activity. For hospitals to participate in NHBOD, they must comply with a newly introduced federal requirement for ICU patients whose deaths are considered imminent after withdrawal of life support. This report describes issues related to NHBOD.METHODSA nonstructured review of selected publications and Web sites was undertaken.RESULTSScientific evidence from autoresuscitation and extracorporeal perfusion suggests that verifying cardiorespiratory arrest lasting 2–5 minutes does not uniformly comply with the dead donor rule, so that the process of organ procurement can be the irreversible event defining death in organ donors. The interest of organ procurement organizations and affiliates in maximizing recovery of transplantable organs introduces self‐serving bias in gaining consent for organ donation and abandons the basic tenet of obtaining true informed consent. The impact of donor management and procurement protocols on end‐of‐life (EOL) care and the potential trade‐off are not disclosed, raising concern about whether potential donors and their families are fully informed before consenting to donation.CONCLUSIONSThe use of comprehensive quality indicators for EOL care can determine the impact of NHBOD on care offered to donors and the effects on families and health care providers. Detailed evaluation of NHBOD will enable the public to make informed decisions about participating in this type of organ donation. Journal of Hospital Medicine 2007;2:324–334. © 2007 Society of Hospital Medicine.

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Development of the University of Wisconsin Donation after Cardiac Death Evaluation Tool

Cited by 112 publications

References 15 publications

Time to Death after Terminal Withdrawal of Mechanical Ventilation: Specific Respiratory and Physiologic Parameters May Inform Physician Predictions

Time to Death after Terminal Withdrawal of Mechanical Ventilation: Specific Respiratory and Physiologic Parameters May Inform Physician Predictions

Donation after cardiocirculatory death in Canada

“Non‐heart‐beating,” or “cardiac death,” organ donation: Why we should care

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