沙特阿拉伯重症监护病房基于神经学死亡判定标准的儿科器官捐献：一项回顾性横断面研究。

Paediatric organ donation following neurological determinants of death in intensive care units in Saudi Arabia: a retrospective cross-sectional study.

机构信息

Department of Pediatrics, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia

King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.

出版信息

BMJ Open. 2023 Aug 16;13(8):e072073. doi: 10.1136/bmjopen-2023-072073.

DOI:10.1136/bmjopen-2023-072073

PMID:37586859

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10432649/

Abstract

OBJECTIVES

The aim of this retrospective cross-sectional study was to assess the performance of paediatric organ donation in intensive care units following neurological determinants of death in Saudi Arabia.

DESIGN

Retrospective cross-sectional study.

SETTING

Paediatric intensive care units at three tertiary centres over 5 years.

PARTICIPANTS

423 paediatric deaths (<14 years) from January 2017 to December 2021.

PRIMARY OUTCOME

Patients were identified as either possible, potential, eligible, approached, consented or actual donors based on organ donation definitions from the WHO, Transplantation Society and UK potential donor audit.

SECONDARY OUTCOME

Secondary outcome was causative mechanisms of brain injury in possible donors. Demographics of the study cohort (age, sex, hospital length of stay (LOS), paediatric intensive care unit LOS, pre-existing comorbidities, admission type and diagnosis category) were compared between possible and non-possible donors. Demographics were also compared between patients who underwent neurological determination of death and patients who did not.

RESULTS

Among the 423 paediatric deaths, 125 (29.6%) were identified as possible donors by neurological criteria (devastating brain insult with likelihood of brain death, Glasgow Coma Score of 3 and ≥2 absent brainstem reflexes). Of them, 41 (32.8%) patients were identified as potential donors (neurological determination of death examinations initiated by the treating team), while only two became actual donors. The eligible death conversion rate was 6.9%. The reporting rate to organ procurement organisation was 70.7% with a consent rate of 8.3%. The most common causes of brain insult causing death were cardiac arrest (44 of 125 patients, 35.2%), followed by traumatic brain injury and drowning (31 of 125 patients, 24.8%), and intracranial bleeding (13 of 125 patients, 11.4%).

CONCLUSION

Major contributors to low actual donation rate were consent, donor identification and donor referral.

摘要

目的

本回顾性横断面研究旨在评估沙特阿拉伯神经死亡决定因素后，重症监护病房中儿科器官捐献的表现。

设计

回顾性横断面研究。

地点

3 家三级中心的儿科重症监护病房，为期 5 年。

参与者

2017 年 1 月至 2021 年 12 月期间，423 名<14 岁的儿科死亡患者。

主要结果

根据世界卫生组织、移植协会和英国潜在供体审计的器官捐献定义，患者被确定为可能、潜在、符合条件、已接触、同意或实际供体。

次要结果

可能供体中脑损伤的病因机制是次要结果。对研究队列的人口统计学特征（年龄、性别、住院时间（LOS）、儿科重症监护病房 LOS、既往合并症、入院类型和诊断类别）进行了比较，比较了可能供体和非可能供体之间的差异。还比较了接受神经死亡确定检查的患者和未接受神经死亡确定检查的患者之间的差异。

结果

在 423 名儿科死亡患者中，125 名（29.6%）根据神经学标准被确定为可能供体（毁灭性脑损伤，伴有脑死亡的可能性，格拉斯哥昏迷评分 3 分，且≥2 个无脑干反射）。其中，41 名（32.8%）患者被确定为潜在供体（治疗团队启动神经死亡确定检查），但只有 2 名成为实际供体。符合条件的死亡转化率为 6.9%。向器官获取组织报告的比例为 70.7%，同意率为 8.3%。导致死亡的脑损伤最常见的原因是心脏骤停（125 例患者中有 44 例，占 35.2%），其次是创伤性脑损伤和溺水（125 例患者中有 31 例，占 24.8%），颅内出血（125 例患者中有 13 例，占 11.4%）。