Evidence map›Paper›PMID 37597867›Full record

ArticleBMJ open2023

Is the process of withdrawal of life-sustaining measures in the intensive care unit different for deceased organ donors compared with other dying patients? A secondary analysis of prospectively collected data.

J Shahin, Nathan B Scales, F Johara, M Hogue, Laura Hornby, Sam Shemie, M Schmidt, P Waldauf, F Duska, Tineke Wind and 2 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
1.2field-weighted citation impact, top 21% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 4 citations in OpenAlex.

  1. Review
  2. Review
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 8 institutions in 3 countries.

J ShahinDivision of Critical Care, Respiratory Epidemiology and Clinical Research Unit, McGill University Faculty of Medicine, Montreal, Québec, Canada Jason.shahin@mcgill.ca.
Nathan B ScalesOttawa Hospital Research Institute, Ottawa, Ontario, Canada.
F JoharaResearch Institute of the McGill University Health Centre, Montreal, Québec, Canada.
M HogueCHEO, Ottawa, Ontario, Canada.
Laura HornbySystem Development, Canadian Blood Services Organ Donation and Transplantation, Ottawa, Ontario, Canada.ORCID 0000-0003-4079-8080
Sam ShemieDivision of Critical Care, Department of Pediatrics, Montreal Childrens Hospital, Montreal, Québec, Canada.
M SchmidtThird Faculty of Medicine, Charles University, Praha, Czech Republic.
P WaldaufThird Faculty of Medicine, Charles University, Praha, Czech Republic.
F DuskaThird Faculty of Medicine, Charles University, Praha, Czech Republic.ORCID 0000-0003-4668-5837
Tineke WindMaastricht University Medical Centre, Maastricht, The Netherlands.
W N Van MookDeparment of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.ORCID 0000-0003-2398-8878
Sonny DhananiCritical Pediatric Critical Care Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Charles University · CZMaastricht University Medical Centre · NLMcGill University Health Centre · CAAgricultural Research Institute of Ontario · CACanadian Blood Services · CAMontreal Children's Hospital · CAOttawa Hospital · CAUniversity of Ottawa · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo investigate whether observable differences exist between patterns of withdrawal of life-sustaining measures (WLSM) for patients eligible for donation after circulatory death (DCD) in whom donation was attempted compared with those patients in whom no donation attempts were made.

settingAdult intensive care units from 20 centres in Canada, the Czech Republic and the Netherlands.

designSecondary analysis of quantitative data collected as part of a large, prospective, cohort study (the Death Prediction and Physiology after Removal of Therapy study).

participantsPatients ≥18 years of age who died after a controlled WLSM in an intensive care unit. Patients were classified as not DCD eligible, DCD eligible with DCD attempted or DCD eligible but DCD was not attempted. PRIMARY AND SECONDARY OUTCOME MEASURES: The process of WLSM (timing and type and, if applicable, dosages of measures withdrawn, dosages of analgesics/sedatives) was compared between groups.

resultsOf the 635 patients analysed, 85% had either cardiovascular support stopped or were extubated immediately on WLSM. Of the DCD eligible patients, more were immediately extubated at the initiation of WLSM when DCD was attempted compared with when DCD was not attempted (95% vs 61%, p<0.0001). Initiation of WLSM with the immediate cessation of cardiovascular measures or early extubation was associated with earlier time to death, even after adjusting for confounders (OR 2.94, 95% CI 1.39 to 6.23, at 30 min). Other than in a few patients who received propofol, analgesic and sedative dosing after WLSM between DCD attempted and DCD eligible but not attempted patients was not significantly different. All patients died.

conclusionsPatients in whom DCD is attempted may receive a different process of WLSM. This highlights the need for a standardised and transparent process for end-of-life care across the spectrum of critically ill patients and potential organ donors.

Indexed as

Intensive Care UnitsPatientsAdultAirway ExtubationCohort StudiesHumansHypnotics and SedativesProspective StudiesHypnotics and SedativesAdult anaesthesiaAdult intensive & critical careAdult palliative careMEDICAL ETHICSTransplant medicineTRANSPLANT MEDICINE

Identifiers

PMID37597867
PMCPMC10441082
OpenAlexW4386003154

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.