Browsing by Subject "Brain death"

Now showing 1 - 5 of 5
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    ACMT Position Statement: Determining Brain Death in Adults After Drug Overdose
    (Springer Nature, 2017-09) Neavyn, Mark J.; Stolbach, Andrew; Greer, David M.; Nelson, Lewis S.; Smith, Silas W.; Brent, Jeffrey; Tormoehlen, Laura M.; Neurology, School of Medicine
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    Alleviating the emotional burden on families during organ donation requests in neurologic patients declared with brain death: the role of timing and circumstances of death
    (Springer Nature, 2025-03-11) Powla, Plamena P.; Turaka, Deekshitha; Fakhri, Farima; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
    Organ donation requests to families often occur during moments of profound grief and create an emotional burden that is compounded by the varying emotional responses to circumstances surrounding death. These responses, in turn, interact with the timing of the request to influence authorization decisions. Understanding the interplay between timing and circumstances of death is crucial for improving authorization rates and addressing the organ donor shortage. The Organ Retrieval and Collection of Health Information for Donation database was used to identify 3,289 potential donors with neurologic mechanisms of brain death. Multivariate logistic regression with interaction between timing and circumstance was used to estimate authorization rates. Results show no significant differences in authorization for requests made within 12 h of death, regardless of circumstance. However, significant differences in authorization were observed between requests made at the time of brain death and those made 12 or more hours later for natural causes, as well as those at 24 or more hours for homicide, motor vehicle accidents, and non-motor vehicle accidents. These findings indicate that the optimal timing for organ donation requests may depend on the emotional intensity of the situation. While quicker requests may be more effective in less emotionally charged cases, extending the time for families to grieve in highly distressing circumstances does not appear to negatively impact authorization rates. Tailoring the timing of donation requests to the circumstances of death, balancing sensitivity with the need for prompt decision-making, could reduce families' emotional burden, ease pressure in decision-making, and help address the shortage of organ donors.
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    Brain Death Secondary to Rocky Mountain Spotted Fever Encephalitis
    (Hindawi, 2020-05-01) Rhodes, Steven D.; Teagarden, Alicia M.; Graner, Brian; Lutfi, Riad; John, Chandy C.; Pediatrics, School of Medicine
    A two-year-old female presented with acutely altered mental status following eight days of fever and rash. She had been camping at an Indiana campground 11 days prior to the onset of illness and was evaluated twice for her fever and rash prior to admission. Laboratory evaluation on admission revealed thrombocytopenia, hyponatremia, and elevated transaminases. The patient developed diffuse cerebral edema, and despite intensive care, the edema led to brain death from Rocky Mountain spotted fever (RMSF). We present this case to highlight the importance of considering RMSF and other tick-borne illnesses in a child with prolonged fever and rash in a nonendemic area and also the difficulty of diagnosis in early stages of disease. A detailed travel history, evaluation of key laboratory findings (white blood count, platelet count, and transaminases), and close follow-up if rash and fevers persist may help to improve detection of RMSF. If a tick-borne illness such as RMSF is suspected, empiric doxycycline therapy should be started immediately, as lab confirmation may take several days and mortality increases greatly after five days of symptoms.
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    Donor heart selection: Evidence-based guidelines for providers
    (Elsevier, 2023) Copeland, Hannah; Knezevic, Ivan; Baran, David A.; Rao, Vivek; Pham, Michael; Gustafsson, Finn; Pinney, Sean; Lima, Brian; Masetti, Marco; Ciarka, Agnieszka; Rajagopalan, Navin; Torres, Adriana; Hsich, Eileen; Patel, Jignesh K.; Adams Goldraich, Livia; Colvin, Monica; Segovia, Javier; Ross, Heather; Ginwalla, Mahazarin; Sharif-Kashani, Babak; Farr, MaryJane A.; Potena, Luciano; Kobashigawa, Jon; Crespo-Leiro, Maria G.; Altman, Natasha; Wagner, Florian; Cook, Jennifer; Stosor, Valentina; Grossi, Paolo A.; Khush, Kiran; Yagdi, Tahir; Restaino, Susan; Tsui, Steven; Absi, Daniel; Sokos, George; Zuckermann, Andreas; Wayda, Brian; Felius, Joost; Hall, Shelley A.; Medicine, School of Medicine
    The proposed donor heart selection guidelines provide evidence-based and expert-consensus recommendations for the selection of donor hearts following brain death. These recommendations were compiled by an international panel of experts based on an extensive literature review.
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    Skin Sympathetic Nerve Activity as a Biomarker for Neurological Recovery during Therapeutic Hypothermia for Cardiac Arrest
    (Elsevier, 2021) Kutkut, Issa; Uceda, Domingo; Kumar, Awaneesh; Wong, Johnson; Li, Xiaochun; Wright, Keith C.; Straka, Susan; Adams, David; Deckard, Michelle; Kovacs, Richard; Chen, Peng-Sheng; Everett, Thomas H., IV.; Medicine, School of Medicine
    Background: Targeted temperature management (TTM) improves neurologic outcome after cardiac arrest. However, better neurologic prognostication is needed. Objective: The purpose of this study was to test the hypothesis that noninvasive recording of skin sympathetic nerve activity (SKNA) and its association with heart rate (HR) during TTM may serve as a biomarker of neurologic status. Methods: SKNA recordings were analyzed from 29 patients undergoing TTM. Patients were grouped based on Clinical Performance Category (CPC) score into group 1 (CPC 1-2) representing a good neurologic outcome and group 2 (CPC 3-5) representing a poor neurologic outcome. Results: Of the 29 study participants, 18 (62%) were deemed to have poor neurologic outcome. At all timepoints, low average skin sympathetic nerve activity (aSKNA) was associated with poor neurologic outcome (odds ratio 22.69; P = .002) and remained significant (P = .03) even when adjusting for presenting clinical factors. The changes in aSKNA and HR during warming in group 1 were significantly correlated (ρ = 0.49; P <.001), even when adjusting for corresponding temperature and mean arterial pressure measurements (P = .017), whereas this correlation was not observed in group 2. Corresponding to high aSKNA, there was increased nerve burst activity during warming in group 1 compared to group 2 (0.739 ± 0.451 vs 0.176 ± 0.231; P = .013). Conclusion: Neurologic recovery was retrospectively associated with SKNA. Patients undergoing TTM who did not achieve neurologic recovery were associated with low SKNA and lacked a significant correlation between SKNA and HR. These preliminary results indicate that SKNA may potentially be a useful biomarker to predict neurologic status in patients undergoing TTM.