Brain death in children: a retrospective review of patients at a paediatric intensive care unit

Abstract

Among patients in paediatric intensive care units (PICUs), death is sometimes inevitable despite advances in treatment. Some PICU patients may have irreversible cessation of all brain function, which is considered as brain death (BD). This study investigated demographic and clinical differences between PICU patients with BD and those with cardiopulmonary death. Methods: All children who died in the PICU at a university-affiliated trauma centre between October 2002 and October 2018 were included in this retrospective study. Demographics and clinical characteristics were compared between patients with BD and patients with cardiopulmonary death. Results: Of the 2784 patients admitted to the PICU during the study period, 127 died (4.6%). Of these 127 deaths, 22 (17.3%) were BD and 105 were cardiopulmonary death. Length of PICU stay was shorter for patients with cardiopulmonary death than for patients with BD (2 vs 8.5 days, P=0.0042). The most common mechanisms of injury in patients with BD were hypoxic-ischaemic injury (40.9%), central nervous system infection (18.2%), and traumatic brain injury (13.6%). The combined proportion of accident and trauma-related injury was greater in patients with BD than in patients with cardiopulmonary death (27.3% vs 3.8%, P<0.001). Organ donation was approved by the families of four

Evaluation of Pediatric Brain Death and Organ Donation: 10-Year Experience in a Pediatric Intensive Care Unit in Turkey

“… 13 In most of the multicenter studies evaluating pediatric BD, multiple trauma and traumatic brain injury, hypoxic ischemic injury resulting from cardiac arrest, and intracranial hemorrhages were found to be the leading causes of BD in the pediatric population. 11 ,14- 16 The reason for this difference in etiologies between our study and most of the existing literature, may be that some pediatric cases with BD that occurred after traumatic brain injury had been admitted to the neurosurgical intensive care unit or other departments in our hospital, and therefore they were excluded from our study. The median age in our study was about 7 years, similar to that reported by Gündüz and Joffe.…”

Ethical dilemmas in critically ill children in Hong Kong

“…6,7 However, parents or carers sometimes demand futile treatment for patients in the PICU. 8 A hospital ethics committee may help resolve such matters where the requested treatment may not be in the best interest of the patient. However, even members of an ethics committee may hold different opinions, making ethical decisions difficult.…”

Survival of out-of-hospital cardiac arrest following a return of spontaneous circulation beyond 30 minutes

“…1 However, ROSC within 30 minutes is usually required for a favourable outcome. 2,3 We performed a literature search to determine the longest time to ROSC and survival rates of OHCA in children (Table ). Out-of-hospital cardiac arrest in children has a poor prognosis and prolonged in-hospital resuscitation beyond 30 minutes does not improve survival.…”