External validation of prediction models for time to death in potential donors after circulatory death

Kotsopoulos, Angela M M; Böing-Messing, Florian; Jansen, Nichon; Vos, Piet; Abdo, Wilson F.

doi:10.1111/ajt.14529

Cited by 23 publications

(42 citation statements)

References 35 publications

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“…We did not have data from neuroimaging, which has also been shown to predict the time from WLST to death. 28,29 Death following WLST usually involves a relatively predictable sequence of events, beginning with hypoxemia, followed by hypotension, loss of pulse pressure, and eventual (electrical) asystole. Nevertheless, the onset and relative duration of these time intervals are less predictable.…”

Section: Discussionmentioning

confidence: 99%

“…Among 196 actual DCD donors, times of WLST, onset of hypoxemia (pulse oximetry \ 70%), onset of hypotension (systolic blood pressure \ 60 mmHg or mean arterial pressure \ 50 mmHg), death, and cannulation were documented in 98%, 73%, 77%, 99%, and 85%, respectively. The median [IQR] time from WLST to cannulation and cold perfusion of organs in the operating room was 33 [29][30][31][32][33][34][35][36][37][38][39][40] min in Alberta, compared with 28 [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] min in British Columbia and 29 min in Saskatchewan and Manitoba (P = 0.02). The greater total duration in Alberta was attributable to a longer duration from onset of hypotension to declaration of death (P = 0.02) and time from declaration of death to vascular cannulation (P \ 0.001).…”

Section: Time Intervals From Withdrawal Of Life-sustaining Therapy To Organ Procurementmentioning

confidence: 99%

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Donation after circulatory determination of death in western Canada: a multicentre study of donor characteristics and critical care practices

Kramer

Holliday

Keenan

et al. 2020

Can J Anesth/J Can Anesth

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Purpose Donation after circulatory determination of death (DCD) has been performed in Canada since 2006. Numerous aspects of donor management remain controversial. Methods We performed a multicentre cohort study involving potential DCD donors in western Canada (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017), as well as recipients of their organs, to describe donor characteristics and critical care practices, and their relation to one-year recipient and graft survival. Results There were 257 patients in four provinces that underwent withdrawal of life-sustaining therapies (WLST) in anticipation of possible DCD. The proportion of patients that died within two hours of WLST ranged from 67% to

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Section: Discussionmentioning

confidence: 99%

Section: Time Intervals From Withdrawal Of Life-sustaining Therapy To Organ Procurementmentioning

confidence: 99%

Donation after circulatory determination of death in western Canada: a multicentre study of donor characteristics and critical care practices

Kramer

Holliday

Keenan

et al. 2020

Can J Anesth/J Can Anesth

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“…Two different retrospective data sets were created. One included data from a single hospital (Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands) with a neurosurgical and traumatology focus [ 23 ]. The second data set included nationwide demographic data from 2014 to 2016 of all cDCD donors that did not arrest within the set time frame of circulatory arrest of 120 minutes.…”

Section: Methodsmentioning

confidence: 99%

“…Previous studies on time to circulatory death in cDCD patients found that approximately 50% to 70% will die within 60 minutes after WLST [ 3 , 7 , 15 , 23 , 25 ]. We estimated that approximately 50% of our cohort will have circulatory death within this time frame, which is balanced to patients that will die after this time frame.…”

Section: Methodsmentioning

confidence: 99%

Prediction Model for Timing of Death in Potential Donors After Circulatory Death (DCD III): Protocol for a Multicenter Prospective Observational Cohort Study

Kotsopoulos¹,

Vos²,

Jansen³

et al. 2020

JMIR Res Protoc

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Background Controlled donation after circulatory death (cDCD) is a major source of organs for transplantation. A potential cDCD donor poses considerable challenges in terms of identification of those dying within the predefined time frame of warm ischemia after withdrawal of life-sustaining treatment (WLST) to circulatory arrest. Several attempts have been made to develop models predicting the time between treatment withdrawal and circulatory arrest. This time window determines whether organ donation can occur and influences the quality of the donated organs. However, the selected patients used for these models were not always restricted to potential cDCD donors (eg, patients with cancer or severe infections were also included). This severely limits the generalizability of those data. Objective The objectives of this study are the following: (1) to develop a model predicting time to death within 60 minutes in potential cDCD patients; (2) to validate and update previous prediction models on time to death after WLST; (3) to determine timing and patient characteristics that are associated with prognostication and the decision-making process that leads to initiating end-of-life care; (4) to evaluate the impact of timing of family approach on organ donation approval; and (5) to assess the influence of variation in WLST processes on postmortem organ donor potential and actual postmortem organ donors. Methods In this multicenter observational prospective cohort study, all patients admitted to the intensive care unit of 3 university hospitals and 3 teaching hospitals who met the criteria of the cDCD protocol as defined by the Dutch Transplant Foundation were included. The target of enrolment was set to 400 patients. Previously developed models will be refitted in our data set. To further update previous prediction models, we will apply least absolute shrinkage and selection operator (LASSO) as a tool for efficient variable selection to develop the multivariable logistic regression model. Results This protocol was funded in August 2014 by the Dutch Transplant Foundation. We expect to have the results of this study in July 2020. Patient enrolment was completed in July 2018 and data collection was completed in April 2020. Conclusions This study will provide a robust multimodal prediction model, based on clinical and physiological parameters, that can predict time to circulatory arrest in cDCD donors. In addition, it will add valuable insight in the process of WLST in cDCD donors and will fill an important knowledge gap in this essential field of health care. Trial Registration ClinicalTrials.gov NCT04123275; https://clinicaltrials.gov/ct2/show/NCT04123275 International Registered Report Identifier (IRRID) DERR1-10.2196/16733

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“…Previous studies have tried to identify patient characteristics associated with rapid progression to death after WCRS and have developed predictive models [7][8][9][10][11]. Typical measurable parameters shown to be important include the loss of brainstem reflexes [reflected by the Glasgow Coma Scale (GCS)], high ventilatory requirements (reflected by the oxygenation index), high vasopressor doses, and low sedative and analgesic doses [7,9,10]. Interestingly, in turn, Brieva and co-workers showed these predictive measures correlated with the clinical judgement of likelihood of death made by the treating ICU specialist [8].…”

Section: Introductionmentioning

confidence: 99%

Improving the predictability of time to death in controlled donation after circulatory death lung donors

et al. 2021

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Although the use of donation after circulatory death (DCD) donors has increased lung transplant activity, 25-40% of intended DCD donors do not convert to actual donation because of no progression to asystole in the required time frame after withdrawal of cardiorespiratory support (WCRS).No studies have specifically focussed on DCD lung donor progression. This retrospective study reviewed intended DCD lung donors to make a prediction model of the likelihood of progression to death using logistic regression and classification and regression tree (CART). Between 2014 and 2018, 159 of 334 referred DCD donors were accepted, with 100 progressing to transplant, while 59 (37%) did not progress. In logistic regression, a length of ICU stay ≤ 5 days, severe infra-tentorial brain damage on imaging and use of vasopressin were related with the progression to actual donation. CART modelling of the likelihood of death within 90-minute post-WCRS provided prediction with a sensitivity of 1.00 and positive predictive value of 0.56 in the validation data set. In the nonprogressed DCD group, 26 died within 6 h post-WCRS. Referral received early after ICU admission, with nonspontaneous ventilatory mode, deep coma and severe infra-tentorial damage were relevant predictors. The CART model is useful to exclude DCD donor candidates with low probability of progression.

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External validation of prediction models for time to death in potential donors after circulatory death

Cited by 23 publications

References 35 publications

Donation after circulatory determination of death in western Canada: a multicentre study of donor characteristics and critical care practices

Donation after circulatory determination of death in western Canada: a multicentre study of donor characteristics and critical care practices

Prediction Model for Timing of Death in Potential Donors After Circulatory Death (DCD III): Protocol for a Multicenter Prospective Observational Cohort Study

Improving the predictability of time to death in controlled donation after circulatory death lung donors

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