title: Survey of determination of death after cardiac arrest by intensive care physicians.
abstract: OBJECTIVE
  The controversy regarding death determination in the context of organ donation after cardiocirculatory death requires investigation. We sought to describe the manner in which Canadian adult and pediatric intensive care physicians report death determination after cardiac arrest.
  
  
  METHODS
  Pilot-tested paper survey.
  
  
  METHODS
  Mail out between June and November 2009.
  
  
  METHODS
  Canadian adult and pediatric intensive care physicians.
  
  
  METHODS
  Paper-based survey.
  
  
  RESULTS
  Forty-nine percent of 501 Canadian intensive care physicians responded. Eighty-five percent practiced in tertiary care, university-affiliated centers, and 26% were from pediatric centers. Physicians had a median of 10 yrs (range 0-35) experience. Physicians reported that they performed determination of death after cardiac arrest a median of seven (range 0-60) times per year. Of 11 tests or procedures used, the absence of heart sounds by auscultation, palpable pulse, and breath sounds were the most common, although there was high variability in practice. No diagnostic test/procedure was uniformly performed or omitted. Sixty-five percent of respondents believed autoresuscitation exists and 37% of physicians reported to have seen a possible case during their career. Forty-eight percent had formal training for determining death after cardiac arrest and 22% used guidelines. The majority of respondents agreed that standardized methods for determination of death after cardiac arrest are required in general (69%) and specifically for donation after cardiocirculatory death (91%).
  
  
  CONCLUSIONS
  Intensive care physicians in Canada report: 1) variability in the practice of determining death after cardiac arrest; 2) the existence of autoresuscitation; and 3) a need for standardization of practice. The results of this survey support the need to develop more robust education, guidelines, and standards for the determination of death after cardiac arrest, in general, as well as within the context of donation after cardiocirculatory death.
authors.affiliation: Pediatric Critical Care, Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, McGill University Health Centre Research Institute, McGill University, Canada. sdhanani@cheo.on.ca
authors.forename: Sonny
authors.initials: S
authors.lastname: Dhanani
authors.forename: Roxanne
authors.initials: R
authors.lastname: Ward
authors.forename: Laura
authors.initials: L
authors.lastname: Hornby
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Barrowman
authors.forename: Karen
authors.initials: K
authors.lastname: Hornby
authors.forename: Sam D
authors.initials: SD
authors.lastname: Shemie
mesh_terms: D002170:Canada; D003422:Critical Care / Q000592:standards / Q000706:statistics & numerical data*; D003625:Data Collection; D003643:Death; D006323:Heart Arrest / Q000401:mortality*; D006801:Humans; D010820:Physicians / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data