Dataset Information

Diagnostic test accuracy for cessation of circulation during death determination: a systematic review.

ABSTRACT:

Purpose

To synthesize the available evidence comparing noninvasive methods of measuring the cessation of circulation in patients who are potential organ donors undergoing death determination by circulatory criteria (DCC) with the current accepted standard of invasive arterial blood pressure (IAP) monitoring.

Source

We searched (from inception until 27 April 2021) MEDLINE, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials. We screened citations and manuscripts independently and in duplicate for eligible studies that compared noninvasive methodologies assessing circulation in patients who were monitored around a period of cessation of circulation. We performed risk of bias assessment, data abstraction, and quality assessment using Grading of Recommendations, Assessment, Development, and Evaluation in duplicate and independently. We presented findings narratively.

Principal findings

We included 21 eligible studies (N = 1,177 patients). Meta-analysis was not possible because of study heterogeneity. We identified low quality evidence from four indirect studies (n = 89) showing pulse palpation is less sensitive and specific than IAP (reported sensitivity range, 0.76-0.90; specificity, 0.41-0.79). Isoelectric electrocardiogram (ECG) had excellent specificity for death (two studies; 0% [0/510]), but likely increases the average time to death determination (moderate quality evidence). We are uncertain whether point-of-care ultrasound (POCUS) pulse check, cerebral near-infrared spectroscopy (NIRS), or POCUS cardiac motion assessment are accurate tests for the determination of circulatory cessation (very low-quality evidence).

Conclusion

There is insufficient evidence that ECG, POCUS pulse check, cerebral NIRS, or POCUS cardiac motion assessment are superior or equivalent to IAP for DCC in the setting of organ donation. Isoelectric ECG is specific but can increase the time needed to determine death. Point-of-care ultrasound techniques are emerging therapies with promising initial data but are limited by indirectness and imprecision.

Study registration

PROSPERO (CRD42021258936); first submitted 16 June 2021.

SUBMITTER: Klowak JA

PROVIDER: S-EPMC10202983 | biostudies-literature | 2023 Apr

REPOSITORIES: biostudies-literature

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Publications

Diagnostic test accuracy for cessation of circulation during death determination: a systematic review.

Klowak Jennifer A JA Nguyen Anna-Lisa V AV Malik Abdullah A Hornby Laura L Doig Christopher J CJ Kawchuk Joann J Sekhon Mypinder M Dhanani Sonny S

Canadian journal of anaesthesia = Journal canadien d'anesthesie 20230401 4

<h4>Purpose</h4>To synthesize the available evidence comparing noninvasive methods of measuring the cessation of circulation in patients who are potential organ donors undergoing death determination by circulatory criteria (DCC) with the current accepted standard of invasive arterial blood pressure (IAP) monitoring.<h4>Source</h4>We searched (from inception until 27 April 2021) MEDLINE, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials. We screened citations and manu ...[more]

PMID: 37138156

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Dataset Information

Diagnostic test accuracy for cessation of circulation during death determination: a systematic review.

Purpose

Source

Principal findings

Conclusion

Study registration

Publications

Diagnostic test accuracy for cessation of circulation during death determination: a systematic review.

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