Background

Rates of paediatric organ donation in the UK remain relatively low, despite public awareness campaigns. As of 2020, England will join the other nations of the UK with an “opt out” scheme for organ donation. However this will not include children, so it is worth considering what other factors may have affected paediatric organ donation rates after confirmation of brainstem death over time.

Objectives

To analyse the outcome of children with confirmed brain stem death, including organ donation rates, on a regional tertiary UK PICU between 2003 and 2017.

Methods

Data was obtained for children who were confirmed brainstem dead on PICU from the unit databases and clinical records at Bristol Royal Hospital for Children, UK, over two periods, 2003-2009 and 2010-2017, covering 15 years in total.

Results

48 children had brainstem death confirmed during their admission to PICU.

Organ donation rates improved during the latter period (12/33 [36%] vs 3/15 [20%]) but over a third of these children (17/48) could not become donors, as they underwent a Coroner’s post mortem.

Conclusion

Although organ donation rates may be improving, a significant proportion of children who were confirmed brain dead may not be offered as donors as they undergo Coroner’s post mortems. To improve paediatric donation rates further, consideration should be given to potential alternatives to full post mortem examinations.

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%).

Background

Predicting which extremely preterm infants (EPI, <28 weeks’) will be successfully extubated to non-invasive ventilation is difficult. We aimed to compare the characteristics and outcomes of EPI who had extubation success and failure.

Objectives

To understand the differences in infants who are unsuccessfully extubated from invasive mechanical ventilation compared to their successfully extubated counterparts.

Methods

Dual centre retrospective audit of the first extubation of EPI conducted between 2016-2017. Extubation failure was defined as reintubation within 7 days.

Results

one hundred of 198 (50.51%) EPI required reintubation. There were important differences in the characteristics of infants in both groups. Infants requiring reintubation had poorer outcomes than those who did not (table). In a multivariable regression model GA remained the only significant predictor of extubation success (area under a receiver operating characteristic curve = 0.73).

Conclusion

Lower GA and birthweight and greater ventilator support are associated with an increased risk of extubation failure. Failure is associated with longer durations of supplemental oxygen and hospitalisation and an increased risk of BPD.