title: A managed protocol for treatment of deceased potential donors reduces the incidence of cardiac arrest before organ explant.
abstract: OBJECTIVE
  To assess the effect of the application of a managed protocol for the maintenance care of deceased potential multiple organ donors at two hospitals.
  
  
  METHODS
  A before (Phase 1)/after (Phase 2) study conducted at two general hospitals, which included consecutively potential donors admitted to two intensive care units. In Phase 1 (16 months), the data were collected retrospectively, and the maintenance care measures of the potential donors were instituted by the intensivists. In Phase 2 (12 months), the data collection was prospective, and a managed protocol was used for maintenance care. The two phases were compared in terms of their demographic variables, physiological variables at diagnosis of brain death and the end of the process, time to performance of brain death confirmatory test and end of the process, adherence to bundles of maintenance care essential measures, losses due to cardiac arrest, family refusal, contraindications, and the conversion rate of potential into actual donors. Student's t- and chi-square tests were used, and p-value < 0.05 was considered to be significant.
  
  
  RESULTS
  A total of 42 potential donors were identified (18 in Phase 1 and 24 in Phase 2). The time interval between the first clinical assessment and the recovery decreased in Phase 2 (Phase 1: 35.0±15.5 hours versus Phase 2: 24.6±6.2 hours; p = 0.023). Adherence increased to 10 out of the 19 essential items of maintenance care, and losses due to cardiac arrest also decreased in Phase 2 (Phase 1: 27.8 versus 0% in Phase 2; p = 0.006), while the convertion rate increased (Phase 1: 44.4 versus 75% in Phase 2; p = 0.044). The losses due to family refusal and medical contraindication did not vary.
  
  
  CONCLUSIONS
  The adoption of a managed protocol focused on the application of essential measures for the care of potential deceased donors might reduce the loss of potential donors due to cardiac arrest.
authors.affiliation: Centro Hospitalar Unimed - CHU - Joinville (SC), Brazil. glauco.w@brturbo.com.br
authors.forename: Glauco Adrieno
authors.initials: GA
authors.lastname: Westphal
authors.forename: Viviane Renata
authors.initials: VR
authors.lastname: Zaclikevis
authors.forename: Kalinca Daberkow
authors.initials: KD
authors.lastname: Vieira
authors.forename: Rodrigo de Brito
authors.initials: Rde B
authors.lastname: Cordeiro
authors.forename: Marina Borges W
authors.initials: MB
authors.lastname: Horner
authors.forename: Thamy Pellizzaro de
authors.initials: TP
authors.lastname: Oliveira
authors.forename: Robson
authors.initials: R
authors.lastname: Duarte
authors.forename: Geonice
authors.initials: G
authors.lastname: Sperotto
authors.forename: Georgiana da
authors.initials: Gd
authors.lastname: Silveira
authors.forename: Milton
authors.initials: M
authors.lastname: Caldeira Filho
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Coll
authors.forename: Santiago
authors.initials: S
authors.lastname: Yus-Teruel
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