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Autoresuscitation after asystole in patients being considered for organ donation*

Objectives:A fundamental issue in organ donation after circulatory death is the determination of death. There are limited data regarding the incidence and timing of autoresuscitation after asystole. Prevailing guidelines suggest a 2- to 5-min observation after mechanical asystole before the declaration of death. This study tested the hypothesis that a 2-min observation period after asystole is sufficient for the declaration of death in patients being considered for organ donation after circulatory death. Design:Single-center observational study using prospectively collected data. Setting:University hospital, Level I trauma center. Patients:Those patients identified by the organ donation registry that underwent organ donation after circulatory death from 2000 to 2008, during which time the institutional protocol required a 5-min observation period. Interventions:None. Measurements and Main Results:Documentation of medical history, serial Glasgow Coma Scale scores, time of extubation, and time to asystole, hypotension, pulseless electrical activity, and declaration of death were ascertained. Seventy-three patients were identified. The most common mechanism of injury was traumatic brain injury, and eight patients were aged <18 yrs. Patients had a mean Glasgow Coma Scale score of 5 on admission and were taken to organ donation after circulatory death an average of 6.6 days after admission. The average time from extubation to death was 22 mins. No patients exhibited autoresuscitation during the 5-min waiting observation period, including the first 2 mins after asystole. Conclusions:The absence of autoresuscitation in our series suggests that a 2-min observation period is sufficient for the determination of death after cardiac arrest, including patients younger than 18 yrs. These data may inform practice guidelines.