Early identification of potential brain death organ donors based on prediction of spontaneous respiratory arrest

Background: This study was designed to build a Nomogarm prediction model of spontaneous respiratory arrest (SRA) in nerocritical patients within 72 hours after brain injury for early identification of potential brain death organ donors.Methods: From October 2017 to May 2019, the neurocritical patients admitted to the First Affiliated Hospital of Sun Yat-sen University, were enrolled. The occurrence of SRA within 72 hours after brain injury was regarded as the time interest point and grouping factor, factors associated with SRA were screened by univariate and multivariate analysis, and then the Nomogarm prediction model was developed. Finally, the Nomogarm prediction model was tested in the validation set.Results: In training set, univariate and multivariate analysis showed that the midline shift (OR=4.56, 95% 1.87-19.21), absent of ambient cistern (OR=4.83, 95% 1.35-16.34), cough reflex absence (OR=3.82, 95% 1.15-12.42), intraventricular hemorrhage (OR=3.16, 95% 1.53-14.52) and serum Na+<125mmol/L (OR=3.06, 95% 1.53-13.44) were associated with SRA within 72 hours. In the training set and validation set, the predicted C index of SRA rate within 72 hours was 0.81 (95% CI 0.76-0.85) and 0.80 (95% CI 0.75-0.83), respectively. Further statistical analysis showed that 140 points, 160 points and 170 points were dangerous cut-off points, of which 140 points, 160 points and 170 points were 30.1%, 65.6% and 93.4% associated with SRA within 72 hours, respectively.Conclusions: Nomogram prediction model based on brain injury assessment parameters can predict the time of SRA in neurocritical patients, and can be used for early identification of potential brain death organ donors.

Non-Invasive Intracranial Pressure Evaluation in an Emergency Room ­ Point-of-Care Ultrasonography

Point-of-care ultrasound ismodifying conducts in emergency care. The variousmedical specialties, in addition to traditional indications in cases of multiple trauma, are using this technique for rapid diagnosis at the bedside without patient mobilization and without radiation. Point-of-care ultrasound in neurocritical patients, through its transorbital window, can estimate the intracranial pressure by a non-invasive method. Through the measurement of the diameter of the optic nerve sheath 3mmposterior to the retina, the intracranial pressure is estimated if the value of the diameter is >5mm, as it has been verified in other studies. The present article describes the most current data on this topic, and it also highlights the need formoremulticentric and randomized trials to determine the correct cut-off points that represent the high sensibility and specificity of the method.