title: Electroencephalographic Recordings During Withdrawal of Life-Sustaining Therapy Until 30 Minutes After Declaration of Death.
abstract: BACKGROUND
  The timing of the circulatory determination of death for organ donation presents a medical and ethical challenge. Concerns have been raised about the timing of electrocerebral inactivity in relation to the cessation of circulatory function in organ donation after cardio-circulatory death. Nonprocessed electroencephalographic (EEG) measures have not been characterized and may provide insight into neurological function during this process.
  
  
  METHODS
  We assessed electrocortical data in relation to cardiac function after withdrawal of life-sustaining therapy and in the postmortem period after cardiac arrest for four patients in a Canadian intensive care unit. Subhairline EEG and cardio-circulatory monitoring including electrocardiogram, arterial blood pressure (ABP), and oxygen saturation were captured.
  
  
  RESULTS
  Electrocerebral inactivity preceded the cessation of the cardiac rhythm and ABP in three patients. In one patient, single delta wave bursts persisted following the cessation of both the cardiac rhythm and ABP. There was a significant difference in EEG amplitude between the 30-minute period before and the 5-minute period following ABP cessation for the group, but we did not observe any well-defined EEG states following the early cardiac arrest period.
  
  
  CONCLUSIONS
  In a case series of four patients, EEG inactivity preceded electrocardiogram and ABP inactivity during the dying process in three patients. Further study of the electroencephalogram during the withdrawal of life sustaining therapies will add clarity to medical, ethical, and legal concerns for donation after circulatory determined death.
authors.affiliation: 1Program in Neurocritical Care,University of Western Ontario,London Health Sciences Centre,London,Ontario,Canada.
authors.forename: Loretta
authors.initials: L
authors.lastname: Norton
authors.affiliation: 3Department of Psychology,University of Western Ontario,London,Ontario,Canada.
authors.forename: Raechelle M
authors.initials: RM
authors.lastname: Gibson
authors.affiliation: 1Program in Neurocritical Care,University of Western Ontario,London Health Sciences Centre,London,Ontario,Canada.
authors.forename: Teneille
authors.initials: T
authors.lastname: Gofton
authors.affiliation: 4Department of Clinical Neurological Sciences,London Health Sciences Centre,London,Ontario,Canada.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Benson
authors.affiliation: 5Division of Pediatric Critical Care,Children's Hospital of Eastern Ontario,Ottawa,ON,Canada.
authors.forename: Sonny
authors.initials: S
authors.lastname: Dhanani
authors.affiliation: 8Montreal Children's Hospital,McGill University Health Centre,Montreal,QC,Canada.
authors.forename: Sam D
authors.initials: SD
authors.lastname: Shemie
authors.affiliation: 8Montreal Children's Hospital,McGill University Health Centre,Montreal,QC,Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Hornby
authors.affiliation: 5Division of Pediatric Critical Care,Children's Hospital of Eastern Ontario,Ottawa,ON,Canada.
authors.forename: Roxanne
authors.initials: R
authors.lastname: Ward
authors.affiliation: 1Program in Neurocritical Care,University of Western Ontario,London Health Sciences Centre,London,Ontario,Canada.
authors.forename: G Bryan
authors.initials: GB
authors.lastname: Young
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D058256:Brain Waves / Q000502:physiology; D002170:Canada; D003643:Death; D004569:Electroencephalography / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000503:physiopathology*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D028761:Withholding Treatment
keywords: Critical care; Determination of death; Donation after circulatory death; EEG; Electrocerebral inactivity; Intensive care; Neurocritical care; Palliative care; Vital signs; withdrawal of life sustaining therapies