title: Determination of death after circulatory arrest by intensive care physicians: A survey of current practice in the Netherlands.
abstract: OBJECTIVE
  Determination of death is an essential part of donation after circulatory death (DCD). We studied the current practices of determination of death after circulatory arrest by intensive care physicians in the Netherlands, the availability of guidelines, and the occurrence of the phenomenon of autoresuscitation.
  
  
  METHODS
  The Determination of Cardiac Death Practices in Intensive Care Survey was sent to all intensive care physicians.
  
  
  RESULTS
  Fifty-five percent of 568 Dutch intensive care physicians responded. Most respondents learned death determination from clinical practice. The most commonly used tests for death determination were flat arterial line tracing, flat electrocardiogram (standard 3-lead electrocardiogram), and fixed and dilated pupils. Rarely used tests were absence pulse by echo Doppler, absent blood pressure by noninvasive monitoring, and unresponsiveness to painful stimulus. No diagnostic test or procedure was uniformly performed, but 80% of respondents perceived a need for standardization of death determination. Autoresuscitation was witnessed by 37%, after withdrawal of treatment or after unsuccessful resuscitation.
  
  
  CONCLUSIONS
  Extensive variability in the practice of determining death after circulatory arrest exists, and a need for guidelines and standardization, especially if organ donation follows death, is reported. Autoresuscitation is reported; this observation requires attention in further prospective observational studies.
authors.affiliation: Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. Electronic address: t.wind@mumc.nl.
authors.forename: Jentina
authors.initials: J
authors.lastname: Wind
authors.affiliation: Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Walther N K A
authors.initials: WN
authors.lastname: van Mook
authors.affiliation: Division of Pediatric Critical Care, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Sonny
authors.initials: S
authors.lastname: Dhanani
authors.affiliation: Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Ernest W L
authors.initials: EW
authors.lastname: van Heurn
mesh_terms: D000776:Anesthesiology; D001795:Blood Pressure Determination; D003422:Critical Care; D003643:Death; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D006323:Heart Arrest / Q000175:diagnosis*; D006801:Humans; D007388:Internal Medicine; D009426:Netherlands; D010820:Physicians; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011681:Pupil Disorders; D011795:Surveys and Questionnaires; D009927:Tissue and Organ Procurement
keywords: Autoresuscitation; Cardiac arrest; Circulatory death; Determination of death; Intensive care; Organ donation