From the Department of Neurology (M.M., A.C.T., J.E., C.M.W., L.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Critical Care Medicine (B.T.K.), Emerson Hospital, Concord; Department of Medicine (P.T.L.), North Shore Medical Center, Salem; Institute for Medical Engineering and Science (U.G., R.P.), Massachusetts Institute of Technology, Boston; Institute for Research in Technology (R.P.), Universidad Pontificia Comillas, Madrid, Spain; and Soar Management Consulting Group (P.S.), Boston, MA.
Neurology. 2021 Apr 13;96(15):e1999-e2005. doi: 10.1212/WNL.0000000000011751. Epub 2021 Feb 26.
To determine whether providing teleneurology (TN) consultations aiding in determination of death by neurologic criteria (DNC) to a bedside intensivist is feasible and whether timely access and expert input increase the quality of the DNC examination and identification of potential organ donors, we reviewed retrospective data related to outcomes of such consultations.
Between November 2017 and March 2019, TN consults were requested for sequential comatose patients in the intensive care unit (ICU). We recorded patients' demographic information, causes leading to coma or suspected DNC, and the results of TN consultations. We obtained data on the number of referrals to the organ bank and number of organ donors.
Ninety-nine consults were performed with a median time from request to start of the consult of 20.2 minutes (interquartile range 5.4-65.3 minutes). Eighty consults were requested for determination of prognosis, whereas 19 consults were requested for supervision of the DNC examination. In 1 of 80 (1.2%) prognostication consults, the patient was determined by the neurologist to require assessment of DNC and was found to meet DNC criteria; determination of DNC occurred in 11 of the 19 (57.9%) consultations for a supervised DNC examination. In a comparison of the pre-TN (94 months) and post-TN (17 months) periods, there was 2.56-fold increase in the proportion of patients meeting DNC criteria who were medically suitable for donation (pre-TN 8.9% vs post-TN 21.1%, = 0.02) and a 2.12-fold increase in the proportion of donors (pre-TN 6.14% vs post-TN 13.1%, = 0.14).
It is feasible to perform TN consultations for patients with severe neurologic damage and to allow expert supervision for DNC examination. Having a teleneurologist as part of the ICU assessment team helped differentiate severe neurologic deficits from DNC and was associated with increase in organ donation.
确定向床边重症监护医生提供远程神经病学（TN）咨询以协助确定神经标准下的死亡（DNC）是否可行，以及是否及时获得专家意见可以提高 DNC 检查的质量并识别潜在的器官捐献者，我们回顾了与此类咨询相关的结果的回顾性数据。
在 2017 年 11 月至 2019 年 3 月期间，ICU 中连续昏迷患者请求进行 TN 咨询。我们记录了患者的人口统计学信息、导致昏迷或疑似 DNC 的原因，以及 TN 咨询的结果。我们获取了向器官库转介的数量和器官捐献者的数量的数据。
进行了 99 次咨询，从请求到咨询开始的中位数时间为 20.2 分钟（四分位距 5.4-65.3 分钟）。80 次咨询是为了确定预后，而 19 次咨询是为了监督 DNC 检查。在 80 次预后咨询中的 1 次（1.2％）中，神经病学家确定患者需要进行 DNC 评估，并发现符合 DNC 标准；在 19 次监督 DNC 检查的咨询中，有 11 次（57.9％）进行了 DNC 判定。在 TN 前（94 个月）和 TN 后（17 个月）期间的比较中，符合 DNC 标准且适合捐赠的患者比例增加了 2.56 倍（TN 前 8.9％ vs TN 后 21.1％， = 0.02），捐赠者的比例增加了 2.12 倍（TN 前 6.14％ vs TN 后 13.1％， = 0.14）。
对患有严重神经损伤的患者进行 TN 咨询并允许专家监督 DNC 检查是可行的。让远程神经病学家成为 ICU 评估团队的一部分有助于区分严重的神经功能障碍和 DNC，并与器官捐赠的增加有关。
