Background

Brain death (BD) consists of irreversible loss of brain activity, caused by a known injury

Objectives

To compare the medical conducts adopted in cases of BD with those practiced in other causes of death

Methods

Retrospective study, evaluated patients who died in PICU from 1/2013 to 12/2016, comparing two groups: With and without BD. Patients who had an inpatient stay of less than two days were excluded. Mann-Whitney and chi-square tests were used for statistical analysis, p <0.05 was considered significant.

Results

There were 114 deaths . Thirty-three patients (30%) had BD and of these 40% were donors. Patients without brain death had significantly more respiratory and hepatic failure. Patients with BD had significantly more neurological failure. There was no statistical difference between use of inotropic drugs in the 48hs and 24hs that preceded and at the time of death between the two groups. Life support limitation plan was recorded in the medical records of 14 (12.2%) patients.When we compared the group with and without limitation of support of life was observed that the group without life support limitation received more norepinephrine (p = 0.02) and less midazolan (p = 0.02) at 48 hs.

Conclusion

There was no difference in the use of vasoactive and inotropic drugs between the groups with and without brain death at 48 hours and 24 hours before death and at the moment of death, indicating that the medical conducts of life support limitation in patients with poor neurological prognosis were not adopted

Background

Chronic illness is the most common cause of death in UK children, with the majority of these deaths occurring in PICU. The length of stay (LOS) in children who die within PICU has increased, but the effect of mode of death is unknown.

Objectives

To analyse LOS and mode of death in all children who died in a regional tertiary UK PICU between 2003 and 2017.

Methods

Data was obtained for children who died on PICU from the unit databases and clinical records at Bristol Royal Hospital for Children, UK, for two consecutive time periods, 2003-2009 and 2010-2017. Data was compared between the two eras using non-parametric statistical tests (Mann Whitney U).

Results

Complete data was obtained for 491 of 492 children who died on PICU. Treatment withdrawal was the most common mode of death across both time periods, 61.8% (2003-2009) vs 65.3% (2010-2017), while the percentage of failed resuscitations fell, 19.1% (2003-2009) vs 11% (2010-2017). The median time to death increased between the two periods for all children who died, plus for those who had treatment withdrawn and those who underwent failed cardiopulmonary resuscitation.

Conclusion

The median time to death for those having treatment withdrawn is increasing, which along with fewer children dying early from failed resuscitation, is prolonging the overall time to death on PICU.

Background

Rates of paediatric organ donation in the UK remain relatively low. Children admitted to PICU with fixed dilated pupils, one of the signs of brainstem death, would seem likely candidates for organ donation. However, it is unclear how many of those presenting with fixed dilated pupils, and who subsequently die on PICU, actually become donors.

Objectives

To analyse the presentation, mode of death and organ donation rates for children with fixed dilated pupils at admission to a regional tertiary UK PICU between 2003 and 2017.

Methods

Data was obtained for children who presented with fixed, dilated pupils and died on PICU from the unit databases and clinical records at Bristol Royal Hospital for Children, UK, for 15 years, 2003-2009 and 2010-2017.

Results

71 children were admitted to PICU with fixed, dilated pupils and subsequently died during that admission.

46/71 (65%) children presented after a witnessed cardiac arrest. Of these 46 children, 12/46 (26%) were declared brain stem dead, but only 4/12 became organ donors, while 7/12 children were referred to the coroner and underwent post-mortem.

Conclusion

Only a small proportion of children admitted to PICU with fixed dilated pupils became organ donors (9/71 = 13%). This was even less likely if the child was admitted after a cardiac arrest (4/46 = 9%).