Naim MY, Hoehn KS, Hasz RD, et al. The Children’s Hospital of Philadelphia’s experience with donation after cardiac death
The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, Philadelphia, PA, USA. Critical care medicine
(Impact Factor: 6.31).
06/2008; 36(6):1729-33. DOI: 10.1097/CCM.0b013e318174dd3d
To describe our experience with pediatric donation after cardiac death.
Retrospective chart review of all cases of donation after cardiac death from 1995 to 2005.
The Children's Hospital of Philadelphia pediatric intensive care unit.
Twelve patients who were pediatric organ donors after cardiac death.
Charts for 12 patients were located, and donation after cardiac death was confirmed. There were two females and ten males. Patient age ranged from 1 to 17 yrs (mean 8 yrs). Four patients had severe traumatic brain injury, and eight patients had hypoxic ischemic encephalopathy. The organs procured were 24 kidneys, eight livers, four lungs, and one pancreas. The organs transplanted were 23 kidneys, four livers, and one pancreas. Ten of 12 cases of withdrawal of life-sustaining support occurred in the operating room area; the other two occurred in the holding area and the postanesthesia care unit. Children received a wide range of medications at the time of extubation. No neuromuscular blockers were used. The time of extubation to time of death ranged from 4 mins to 30 mins, with a mean of 14.5 mins. Death was declared based on cardiac asystole confirmed by auscultation and transthoracic impedance, with organ procurement initiated 5 mins later. Regarding who initiated conversation about donation after cardiac death, nine cases were family initiated, one case was physician initiated, and in two there was a collaborative approach with the physician and representative from the organ procurement organization. Of the organs transplanted, all organs other than one kidney and one split liver graft were functioning at 1 yr post-transplant.
Pediatric donation after cardiac death can be performed successfully; its impact on end-of-life care and bereavement needs further investigation.
Available from: PubMed Central
- "Limited, retrospective information about children considered for DCD in North America had to date yielded data of considerable disparity with regards to the time to death after withdrawal of life-sustaining treatment. Naim and colleagues, in a small series of 12 DCD candidates, found no child to have lived longer than 35 minutes after extubation . Durall et. "
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ABSTRACT: Scant information exists about the time-course of events during withdrawal of life-sustaining treatment. We investigated the time required for end-of-life decisions, subsequent withdrawal of life-sustaining treatment and the time to death.
Prospective, observational study in the ICU of a tertiary paediatric hospital.
Data on 38 cases of withdrawal of life-sustaining treatment were recorded over a 12-month period (75% of PICU deaths). The time from the first discussion between medical staff and parents of the subject of withdrawal of life-sustaining treatment to parents and medical staff making the decision varied widely from immediate to 457 hours (19 days) with a median time of 67.8 hours (2.8 days). Large variations were subsequently also observed from the time of decision to actual commencement of the process ranging from 30 minutes to 47.3 hrs (2 days) with a median requirement of 4.7 hours. Death was apparent to staff at a median time of 10 minutes following withdrawal of life support varying from immediate to a maximum of 6.4 hours. Twenty-one per cent of children died more than 1 hour after withdrawal of treatment. Medical confirmation of death occurred at 0 to 35 minutes thereafter with the physician having left the bedside during withdrawal in 18 cases (48%) to attend other patients or to allow privacy for the family.
Wide case-by-case variation in timeframes occurs at every step of the process of withdrawal of life-sustaining treatment until death. This knowledge may facilitate medical management, clinical leadership, guidance of parents and inform organ procurement after cardiac death.
Available from: Kathy Shaw
Available from: Emilio Olías
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ABSTRACT: A study of the two-input post-regulators is carried out in this
paper. In these post-regulators, only a part of the total power
undergoes a switching conversion process, whereas the remainder of the
power comes up to the load directly, with no power conversion process.
Due to this fact, very high efficiency is achieved. Moreover, the stress
in the semiconductors and the filter size are both much lower than in
standard post-regulators. Two-input post-regulators require two-output
main converters. However, many converter topologies can be easily
adapted to supply two output voltages with no efficiency penalty.
Two-input post-regulators can be used in many power converters.
Multiple-output DC-to-DC converters and AC-to-DC power factor correctors
are two good examples
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