Evidence-Based Checklist to Delay Cardiac Arrest in Brain-Dead Potential Organ Donors
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Published:2023-12-14
Issue:12
Volume:6
Page:e2346901
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ISSN:2574-3805
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Container-title:JAMA Network Open
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language:en
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Short-container-title:JAMA Netw Open
Author:
Westphal Glauco A.123, Robinson Caroline Cabral1, Giordani Natalia Elis14, Teixeira Cassiano56, Rohden Adriane Isabel1, dos Passos Gimenes Bruna1, Guterres Cátia Moreira1, Madalena Itiana Cardoso1, Andrighetto Luiza Vitelo1, Souza da Silva Sabrina1, Barbosa da Silva Daiana1, Sganzerla Daniel1, Cavalcanti Alexandre Biasi7, Franke Cristiano Augusto58, Bozza Fernando Augusto910, Machado Flávia Ribeiro11, de Andrade Joel2, Pontes Azevedo Luciano Cesar12, Schneider Silvana13, Orlando Bianca Rodrigues1415, Grion Cintia Magalhães Carvalho1617, Bezerra Fernando Albuerne18, Roman Fernando Roberto19, Leite Francisco Olon20, Ferraz Siqueira Íris Lima21, Oliveira João Fernando Piccolo22, de Oliveira Lúcio Couto23, de Melo Maria de Fátima Rodrigues Buarque24, Leal Patrícia Berg Gonçalves Pereira25, Diniz Pedro Carvalho26, Moraes Rafael Barbarena27, Salomão Pontes Daniela Ferreira28, Araújo Queiroz Josélio Emar28, Hammes Luciano Serpa1, Meade Maureen O.29, Rosa Regis Goulart1, Falavigna Maicon13031, de Stefano Laercio M32, Cleto Marina CA32, Zambrini Aline R32, Banin Cintia32, Douglas Maria OG32, Borba Renato L32, Boni Daniela32, Monteiro Eliza MP32, Manoel Airton LO32, Parioto Neto Ciro32, Lovato Wilson J32, Cerantola Rodrigo B32, Palma Leonardo C32, Rojas Salomon O32, Veiga Viviane C32, Freitas Luciana S32, Marco Roberto32, Hirata Fabiano32, Vieira Cinthia C32, Jackiu Miriam32, Santiago Alessandra D32, Bertin Márcia R32, Otsubo Luiz32, Marques Ana L P32, de Almeida Josileide F32, Torres Martha P32, dos Santos Gileade G32, Gomes Márcia C32, Nunes Caio L S32, Moreira Felipe A32, Simões Daniele S M V32, Reis Leonardo d S32, de Souza Mariane S L32, de Castro Rismaria M R32, Gameiro Valeska M N32, Ferrari Regiane C32, Ramos Daniela B32, Passos Leny N M32, Sodré América C B M32, Pedrosa Rita C M P32, de Almeida Eliana R B32, Hirata Camila32, Matiello Raquel DC32, Machado Maria S32, Castro Fernando32, Gonçalves Gustavo P32, de Oliveira Maria I G32, Cançado Omar L32, Miozzo Claire C32, Montenegro Gyanna L M M32, Gomes Noemy A C32, Badoch Arlene T C G32, Sarlo Rodrigo A32, Pereira Gabriel T M32, Marques Raissa M32, Toledo Suely L A32, Ruhling Ricardo K32, Fernandez Benito O32, Spalini Agenor32, Monteiro Francisco A S32, Medeiros Marizete P32, de Oliveira Caroline L32, Rech Gabriela S32, Benck Patrícia S32, Tomé Silvana R32, de Mendonça Silvia EM32, Wecki Vitor A32, Machado Miriam MV32, Segovia Carmen32, Ghellere Aline32, da Silva Charlene V32, da Rocha Dagoberto F32, Berbigier Eduardo32, Leal Edvaldo32, Pfuetzenreifer Felipe32, Bourscheit Fernando32, Toribio José L32, Tannous Luana32, Heberle Luana32, Knihs Neide32, Cardoso Paulo RC32, Grando Marcelo32, Veras Ludmylla BV32, Albuquerque Gigliane MA32, Hashimoto Régis A32, Teles Mateus RT32, Cruz Rosely B32, Pinheiro Nelson AC32, de Moraes Janapina MMF32, Balzan Claudete M32, Leite Lúcia RA32, Oliveira Lis DP32, Pereira Thattyane B32, Novillo Edwin F32, Batista Maxwendell G32, de Campos Silvecler C32, Ferreira Marcelo S32, Bezerra Helen CA32, Matos Paulo HL32, Feijó Janaína32, Ferreira Dernivania A32, Machado Ana PRB32, Santos Poliana N32, de Souza Felipe FR32, de Oliveira Daniela C32, Dias Reis Graças M32, Rolim Ana V32, Magalhães Samira R32, Reis Cleiriane32, Costa Joel I32, Carneiro Larissa SP32, Passos Márcia MVS32, dos Santos Gustavo M32, de Souza José WB32, Marinho Bruna BO32, Salles Luiz DP32, Gurgel José H32, Fontenele Iranildo P32, Bezerra Layanny TL32, Costa Cristiano A32, da Costa Israel F32, Pinheiro Diego BS32, de Moura Denise M32, Cantidio Suzana32, Moreira Jéssica PSL32, Belém Telma A32, Florentino Symoni BFQ32, Carvalho Bruna S32, Mendes Ciro L32, do Nascimento Igor M32, Araújo Paloma E32, Araújo Maryjane AO32, Alves Alexandre AG32, Lima Heloisa RFO32, Carvalho Silvia HCA32, Aragão Clayton32, Santos Marko AF32, Moraes Luiza MN32, Sobrinho Henrique LCN32, Siqueira Sylvia HAL32, Silva Janaína R32, Moraes Samyra P32, Carvalho Janaína CW32, Silva Luiz H32, Silva Viviane M32, Fornaciari Jander P32, Curty Ana PN32, Soares Ivens G32, Pimentel Caroline S32, Castilho Marco AM32, Veiga Tânia LAA32, Carvalho Frederico B32, Ferreira Natasha P32, Freitas Sylmara JZ32, Sousa Fernanda CP32, Laura Chen32, Nobre Vandack A32, Pereira Christiane FMHM32, Gomes Amélia C32, Oliveira Jeová F32, Nasser Paula G32, Ferreira Alexandre S32, Moura Mara R32, Oliveira Claudio D32, Moreira Andressa S32, Santiago Raquel B32, Oliveira Marina F32, Neves Ana OS32, Silva Rodrigo CG32, Almeida Roberto32, Zili Karin A32, Fernandes Alexsandro JS32, Mezzaroba Ana L32, Festti Josiane32, Larangeira Alexandre S32, Dhaese Thomas M32, Hanke Simone Macedo32, Arcaro Guilherme32, Duarte Pericles AD32, Padilha Elaine F32, Tchaicka Cleber32, Ayres Lizandra O32, Tanita Marcos T32, Oliveira Carlos A32, Germano Almir32, Dell´Agnolo Catia M32, Freitas Rosane A32, Barbosa Ellen S32, Mezzavila Vanessa M32, Santos Renata32, Rigon Pedro32, Weiwanko Itamar32, Mroginski Cristiano32, Pasa Waldir A32, Ramthun Maikel32, Pereira Jullye C32, Flores César AB32, Cwiertnia Patrícia B32, Risson Ricardo GZ32, Taborda Joseane A32, Vieira Mayara F32, Cassolli Tatiana E 32, Singer Mariana P32, Pereira Rosiane O32, Oliveira Jaciara R32, Lemos Melina AS32, Toniol Vivianne CB32, Souza Mariza A32, Hayashi Ângelo Y32, Paula Priscila LL32, Bezerra Elza de Lara32, Borges Fernanda GZ32, Ramos Elaine S32, Marochi Cibele A32, Braga Jessyca32, Sodré Alexander O32, Entrago Letícia AP32, Barcelos Thiago M32, de Jesus Roberta C32, Vianna Vitor M32, de Melo Mônica SFS32, Vaz Tais CB32, Santos Flávio E32, Begni Vladimir S32, Cardoso Fábio F32, Mallmann Lucas32, Calvi Adriana32, Franco Nelson B32, Oliveira Angélica32, Alves Flávio AC32, Silveira Manoel NO32, da Fonseca Deisi LO32, Santini Susana32, Rodrigues Filho Edison M32, Bonow Fernanda P32, Susin Ruth32, Machado Kellen PM32, de Aguiar Danielle M32, Scheneider Caroline S32, Braz Lidiane C32, do Bem Carlos FP32, Rech Tatiana H32, de Aquino Vivian W32, Teixeira Luciano O32, Mendonça Viviane A32, Bizarro Silvia Z32, Calvete José O32, Maito Lina32, Henrich Sabrina F32, PeLlizzaro Larissa A32, Mecatti Giovana C32, Filiponi Thiago C32, Barbosa Felipe FP32, Gozzoli Flávia32, Ribeiro André S32, Rosateli Paulo HP32, Waked Zeher M32, Quintal Ana P32, Lobo Suzana MA32, Sampaio Regiane32, Morais Marcos32, Rol James L32, Orlando Bianca R32, Grion Cintia MC32, Bezerra Fernando A32, Roman Fernando R32, Leite Francisco O32, Siqueira Íris LF32, Oliveira João FP32, de Oliveira LucioC32, de Melo Maria FRB32, Leal Patrícia BGP32, Diniz Pedro C32, Moraes Rafael B32, Pontes Daniela FS32, Queiroz Joselio EA32, Westphal Glauco A32, Robinson Caroline C32, Rohden Adriane I32, Gimenes Bruna P32, Guterres Cátia M32, Madalena Itiana C32, Andrighetto Luiza V32, Giordani Natalia E32, da Silva Sabrina S32, da Silva Daiana B32, Sganzerla Daniel32, Falavigna Maicon32, Rosa Regis G32, Cavalcanti Alexandre B32, Teixeira Cassiano32, Franke Cristiano A32, Machado Flávia R32, de Andrade Joel32, de Azevedo Luciano CP32, Hammes Luciano S32, Meade Maureen O32,
Affiliation:
1. Responsabilidade Social–Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS), Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil 2. Central Estadual de Transplantes de Santa Catarina, Rua Esteves Júnior, Florianópolis, Santa Catarina, Brazil 3. Centro Hospitalar Unimed Joinville and Hospital Municipal São José, Joinville, Santa Catarina, Brazil 4. Postgraduate Programme in Epidemiology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil 5. Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil 6. Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil 7. HCor Research Institute, São Paulo, São Paulo, Brazil 8. Hospital de Pronto de Socorro (HPS), Porto Alegre, Rio Grande do Sul, Brazil 9. National Institute of Infectious Disease Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil 10. Instituto D’Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Rio de Janeiro, Brazil 11. Disciplina de Anestesiologia, Dor e Medicina Intensiva, Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo, Brazil 12. Hospital Israelita Alber Einstein, Morumbi, São Paulo, São Paulo, Brazil 13. Department of Statistics, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil 14. Hospital Universitário São Francisco de Paula, Pelotas, Rio Grande do Sul, Brazil 15. Hospital Escola, Universidade Federal de Pelotas (UFPEL), Pelotas, Rio Grande do Sul, Brazil 16. Hospital Universitário Regional do Norte do Paraná, Londrina, Paraná, Brazil 17. Hospital Evangélico de Londrina, Londrina, Paraná, Brazil 18. Hospital Regional Tarcísio de Vasconcelos Maia, Mossoró, Rio Grande do Norte, Brazil 19. Hospital Bom Jesus, Toledo, Paraná, Brazil 20. Hospital Regional Norte, Centro Universitário Inta (UNINTA), Sobral, Ceará, Brazil 21. Hospital de Urgência e Emergência de Rio Branco (HUERB), Rio Branco, Acre, Brazil 22. Hospital de Base, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil 23. Hospital Geral Cleriston Andrade, Feira de Santana, Bahia, Brazil 24. Hospital da Restauração, Recife, Pernambuco, Brazil 25. Associação Beneficente da Santa Casa de Campo Grande, Campo Grande, Mato Grosso do Sul, Brazil 26. Hospital Universitário, Universidade Federal do Vale do São Francisco (HU/UNIVASF), Petrolina, Pernambuco, Brazil 27. Intensive Care, HCPA, Porto Alegre, Rio Grande do Sul, Brazil 28. General Coordination Office, National Transplant System, Brazilian Ministry of Health, Esplanada dos Ministérios, Bloco G, Edifício Sede, Brasília, Distrito Federal, Brazil 29. Department of Medicine, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada 30. National Institute for Health Technology Assessment, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil 31. Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada 32. for the DONORS (Donation Network to Optimize Organ Recovery Study) Investigators and the BRICNet (Brazilian Research in Intensive Care Network)
Abstract
ImportanceThe effectiveness of goal-directed care to reduce loss of brain-dead potential donors to cardiac arrest is unclear.ObjectiveTo evaluate the effectiveness of an evidence-based, goal-directed checklist in the clinical management of brain-dead potential donors in the intensive care unit (ICU).Design, Setting, and ParticipantsThe Donation Network to Optimize Organ Recovery Study (DONORS) was an open-label, parallel-group cluster randomized clinical trial in Brazil. Enrollment and follow-up were conducted from June 20, 2017, to November 30, 2019. Hospital ICUs that reported 10 or more brain deaths in the previous 2 years were included. Consecutive brain-dead potential donors in the ICU aged 14 to 90 years with a condition consistent with brain death after the first clinical examination were enrolled. Participants were randomized to either the intervention group or the control group. The intention-to-treat data analysis was conducted from June 15 to August 30, 2020.InterventionsHospital staff in the intervention group were instructed to administer to brain-dead potential donors in the intervention group an evidence-based checklist with 13 clinical goals and 14 corresponding actions to guide care, every 6 hours, from study enrollment to organ retrieval. The control group provided or received usual care.Main Outcomes and MeasuresThe primary outcome was loss of brain-dead potential donors to cardiac arrest at the individual level. A prespecified sensitivity analysis assessed the effect of adherence to the checklist in the intervention group.ResultsAmong the 1771 brain-dead potential donors screened in 63 hospitals, 1535 were included. These patients included 673 males (59.2%) and had a median (IQR) age of 51 (36.3-62.0) years. The main cause of brain injury was stroke (877 [57.1%]), followed by trauma (485 [31.6%]). Of the 63 hospitals, 31 (49.2%) were assigned to the intervention group (743 [48.4%] brain-dead potential donors) and 32 (50.8%) to the control group (792 [51.6%] brain-dead potential donors). Seventy potential donors (9.4%) at intervention hospitals and 117 (14.8%) at control hospitals met the primary outcome (risk ratio [RR], 0.70; 95% CI, 0.46-1.08; P = .11). The primary outcome rate was lower in those with adherence higher than 79.0% than in the control group (5.3% vs 14.8%; RR, 0.41; 95% CI, 0.22-0.78; P = .006).Conclusions and RelevanceThis cluster randomized clinical trial was inconclusive in determining whether the overall use of an evidence-based, goal-directed checklist reduced brain-dead potential donor loss to cardiac arrest. The findings suggest that use of such a checklist has limited effectiveness without adherence to the actions recommended in this checklist.Trial RegistrationClinicalTrials.gov Identifier: NCT03179020
Publisher
American Medical Association (AMA)
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