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Survey of determination of death after cardiac arrest by intensive care physicians*

Dhanani, Sonny MD, FRCPC; Ward, Roxanne RN, BA (Psy); Hornby, Laura MSc; Barrowman, Nicholas J. PhD; Hornby, Karen BScN, MSc; Shemie, Sam D. MD, FRCPCfor the Canadian Critical Care Trials Group, and the Bertram Loeb Research Consortium in Organ and Tissue Donation

doi: 10.1097/CCM.0b013e31823e9898
Clinical Investigations

Objective: The controversy regarding death determination in the context of organ donation after cardiocirculatory death requires investigation. We sought to describe the manner in which Canadian adult and pediatric intensive care physicians report death determination after cardiac arrest.

Design: Pilot-tested paper survey.

Setting: Mail out between June and November 2009.

Subjects: Canadian adult and pediatric intensive care physicians.

Intervention: Paper-based survey.

Main Results: Forty-nine percent of 501 Canadian intensive care physicians responded. Eighty-five percent practiced in tertiary care, university-affiliated centers, and 26% were from pediatric centers. Physicians had a median of 10 yrs (range 0–35) experience. Physicians reported that they performed determination of death after cardiac arrest a median of seven (range 0–60) times per year. Of 11 tests or procedures used, the absence of heart sounds by auscultation, palpable pulse, and breath sounds were the most common, although there was high variability in practice. No diagnostic test/procedure was uniformly performed or omitted. Sixty-five percent of respondents believed autoresuscitation exists and 37% of physicians reported to have seen a possible case during their career. Forty-eight percent had formal training for determining death after cardiac arrest and 22% used guidelines. The majority of respondents agreed that standardized methods for determination of death after cardiac arrest are required in general (69%) and specifically for donation after cardiocirculatory death (91%).

Conclusions: Intensive care physicians in Canada report: 1) variability in the practice of determining death after cardiac arrest; 2) the existence of autoresuscitation; and 3) a need for standardization of practice. The results of this survey support the need to develop more robust education, guidelines, and standards for the determination of death after cardiac arrest, in general, as well as within the context of donation after cardiocirculatory death.

From the Pediatric Critical Care (SD), Clinical Research Unit (RW, NJB), Children’s Hospital of Eastern Ontario Research Institute; McGill University Health Centre Research Institute (LH, KH), Division of Critical Care (SDS), Montreal Children’s Hospital, McGill University; and Faculty of Medicine (SD, NJB), University of Ottawa, Canada.

*See also p. 1655.

Supported, in part, by a grant from the Research Institute of the Children’s Hospital of Eastern Ontario.

The authors have not disclosed any potential conflicts of interest.

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© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins