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Brain death and potential organ donors in neurocritical care mortality
© Spatenkova et al.; 2015
Published: 1 October 2015
Neurocritical care mortality has potential for organ donation due to brain death.
The aim of this study was to analyse the neurocritical care mortality rate and potential brain-dead organ donors.
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.
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%).
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.
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.