ABSTRACT
Background: With analyzing the incongruent phenomenon of electrical active and cerebral blood flow in brain death determination and screening the related factors, offer correct explanations and countermeasure to ensure the successful implementation of donation after brain death.Methods: Relevant clinical data of potential brain death organ donors were prospectively collected between June 2018 and May 2019. The related parameters of neurological examination, laboratory examination and neuroimaging examination during the period of brain death determination were dynamically recorded. Separation phenomenon was used as grouping factors to screen the factors related to separation phenomena through univariate and multivariate analysis.Results: According to the inclusion criteria, 127 patients were included in the study. Among 22 patients (17.3%) with incongruent phenomenon, 17 (77.3%) had electrical silence earlier than cerebral blood flow arrest, and 9 (22.7%) had cerebral blood flow arrest earlier than electrical silence. Univariate and multivariate analysis showed that age <14 years (OR=6.25, 95%CI 1.21-32.22, p=0.028), SBP≥140 mmHg (OR=7.43, 95%CI 1.62-33.99, p=0.010), primary brainstem injury (OR=15.89, 95%CI 3.04-82.93, p=0.006), spontaneous respiratory arrest time ≤72 hours (OR=11.96, 95%CI 1.59-89.78, p=0.009) and decompression craniotomy(unilateral or bilateral) (OR=16.28, 95%CI 2.25-117.73, p=0.001) were associated with separation phenomenon..Conclusions: Separation phenomenon is a common during the confirmation test of brain death determination in China, and should be correctly recognized. To adopt corresponding measures according to risk factors is useful for successful implementation of donation after brain death.
ABSTRACT
Objective To investigate the correlation between the plasma unconjugated bilirubin(UCB)and electrical activity of brain in term neonates with hyperbilirubinemia,and explore the parameters that possess the prognostic value and deduce a series of discriminant for prognostic judgment.Methods Thirty-two neonates with hyperbilirubinemia and 31 neonates without hyperbilirubinema(control group)were studied with standard EEG,and they were assessed for their neurological development in 3 and 6 months.A statistical method of Bayes Discriminant analysis was adopted to set up an equation with values of parameters of EEG,clinic datum and consequence.Stepdic and Dis-grim processes were used to pick out the parameters which had great significance for predicting the outcome of nervous system development.A series of discriminant was deduced for prognostic judgment and then cross validation was performed to assess the accuracy of the discriminant.Results 1.The standard EEG and brain electrical activity map records indicated that the hyperbilirubinemia group had longer maximum duration of interburst interval(IBI),longer mean duration of IBI,lower amplitude under all conditions,more anterior dysrhythmia(AD)in wake,and higher incidence of sleep-wake cycle disturbance.2.The plasma concentration of UCB was linear correlated with AD in wake.3.Gestational age,birth weight,plasma concentration of UCB,burst duration of IBI in trace alternate,amplitude in all sleep state,AD in wake,brief burst not in quiet sleep and sleep-wake cycle disturbance might play important roles in predicting the outcome of neonates with hyperbilirubinemia.Conclusions Cerebral electrical activity is an effective tool for predicting neurologic outcome of neonates with hyperbi-lirubinemia.Cerebral electrical activity and clinic data will provide a new method for accurately predicting neurological development and prognosis.