Volume 3 Supplement 1

ESICM LIVES 2015

Open Access

Brain death and potential organ donors in neurocritical care mortality

  • V Spatenkova1,
  • O Bradac2 and
  • P Suchomel3
Intensive Care Medicine Experimental20153(Suppl 1):A897

https://doi.org/10.1186/2197-425X-3-S1-A897

Published: 1 October 2015

Introduction

Neurocritical care mortality has potential for organ donation due to brain death.

Objectives

The aim of this study was to analyse the neurocritical care mortality rate and potential brain-dead organ donors.

Methods

We performed an analysis of a 10-year prospective observational cohort database of 6138 patients (58.2% of males, mean: age 55.9 ± 14.7 years, body weight 78.3 ± 15.6 kg, body mass index 26.9 ± 4.7, NICU stay 3.8 ± 5.3 days, Acute Physiology and Chronic Health Evaluation II score on admission 10.63 ± 5.2) admitted to a single adult neurointensive care unit (NICU). There were 3462 (56.4%) patients (pts) with brain disease (stroke 43.2%, tumour 31.1%, trauma 13.6%, epilepsy 3.8%, hydrocephalus 3.4%, infection 2.5%, others 2.2%), 10.3% of pts had internal carotid artery stenosis (ACI), 32.6% of pts had spine diseases and 0.7% of pts had other disorders. Mean Glasgow Coma Scale on admission was 13.79 ± 2.51 and Glasgow Outcome scale upon discharge from NICU 3.97 ± 1.13.

Results

From 6138 admitted patients there were 159 (2.6%) cases of NICU mortality with mean length of stay 9.21 ± 10.2. We found no differences in gender (p = 0.804), but mortality rate was significantly higher in acute admissions (p < 0.001), primary admissions and secondary to 24 hours than secondary after 24 hours (p < 0.001). Comparing the diagnoses, there was a significantly higher mortality rate in pts with brain diseases (95.6% of deceased pts, p < 0.001) than in ACI (0.6%), spine (1.9%) and from others (1.9%). From brain diseases there was significantly higher mortality in stroke pts (67.1%) than in trauma (17.8%), tumour (10.5%), hydrocephalus (2%), infection (2%) and epilepsy (0.7%), There were 23 (14.5%) pts with clinical signs of brain death, of which 13 (56.5%) became organ donors. Main reason of non-harvesting donors was hemodynamic instability (16.7%) and family reluctance (12.5%).

Conclusions

The results of our prospective databases showed that brain damage is the most common cause of mortality in neurointensive care; however there was a low proportion of clinical sign of brain death and not all potential donors were harvested.

Authors’ Affiliations

(1)
Neurocenter, Neurointensive Care Unit, Regional Hospital
(2)
Military University Hospital and First Medical School, Department of Neurosurgery, Charles University
(3)
Department of Neurosurgery, Neurocenter

Copyright

© Spatenkova et al.; 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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