Department of Transplantation Surgery, Medical University of Graz, Graz, Austria.
Transpl Int. 2012 Apr;25(4):481-92. doi: 10.1111/j.1432-2277.2012.01437.x. Epub 2012 Feb 20.
Donation after cardiac death (DCD) is under investigation because of the lack of human donor organs. Required times of cardiac arrest vary between 75s and 27min until the declaration of the patients' death worldwide. The aim of this study was to investigate brain death in pigs after different times of cardiac arrest with subsequent cardiopulmonary resuscitation (CPR) as a DCD paradigm. DCD was simulated in 20 pigs after direct electrical induction of ventricular fibrillation. The "no-touch" time varied from 2min up to 10min; then 30min of CPR were performed. Brain death was determined by established clinical and electrophysiological criteria. In all animals with cardiac arrest of at least 6min, a persistent loss of brainstem reflexes and no reappearance of bioelectric brain activity occurred. Reappearance of EEG activity was found until 4.5min of cardiac arrest and subsequent CPR. Brainstem reflexes were detectable until 5min of cardiac arrest and subsequent CPR. According to our experiments, the suggestion of 10min of cardiac arrest being equivalent to brain death exceeds the minimum time after which clinical and electrophysiological criteria of brain death are fulfilled. Therefore shorter "no-touch" times might be ethically acceptable to reduce warm ischemia time.
由于缺乏人类供体器官，心脏死亡后的捐献（DCD）正在研究中。在世界范围内，宣布患者死亡之前，心脏停搏所需的时间在 75 秒至 27 分钟之间不等。本研究的目的是研究不同心脏停搏时间后行随后心肺复苏（CPR）的猪的脑死亡，作为 DCD 范例。在 20 头猪中直接电诱导心室颤动后模拟 DCD。“无接触”时间从 2 分钟到 10 分钟不等；然后进行 30 分钟的 CPR。脑死亡通过既定的临床和电生理标准确定。在至少 6 分钟心脏骤停的所有动物中，脑干反射持续丧失且无生物电脑活动重现。在心脏骤停和随后的 CPR 中，直到 4.5 分钟才发现 EEG 活动的重现。脑干反射可检测到心脏骤停和随后的 CPR 直到 5 分钟。根据我们的实验，建议心脏停搏 10 分钟等同于脑死亡，超过了满足脑死亡临床和电生理标准的最短时间。因此，较短的“无接触”时间可能在伦理上可以接受，以减少热缺血时间。
