在体外膜氧化中通过神经学标准确定死亡的挑战 - 一个中心的经验
David X Zhao1, Giorgio Caturegli1, Christopher Wilcox2
1Division of Neurosciences Critical Care, Departments of Neurology, Neurosurgery, Anesthesiology, and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Perfusion
|June 30, 2023
概括
在体外膜氧化 (ECMO) 患者中,通过神经学标准 (DNC) 确定死亡是具有挑战性的. 在大多数符合DNC标准的ECMO患者中,无呼吸试验 (AT) 安全地使用,证明与神经学检查一致.
科学领域:
- 神经学 神经学
- 临界护理医学 临界护理医学
- 心血管外科心血管外科
背景情况:
- 通过神经学标准 (DNC) 确定通过体外膜氧化 (ECMO) 支持的患者的死亡存在独特的挑战.
- 现有的DNC测定协议,包括呼吸暂停测试 (AT),需要对ECMO患者进行仔细的调整.
研究的目的:
- 描述诊断标准,并确定在第三级护理中心成年ECMO患者中确定DNC的障碍.
- 评估ECMO患者的呼吸暂停测试的安全性和有效性.
主要方法:
- 对前性观察性神经监测研究的回顾性审查.
- 包括2016年6月至2022年3月的成人VA-ECMO和VV-ECMO患者.
- 遵守2010年美国神经病学会指南和2020年世界脑死亡项目建议.
主要成果:
- 八名 (2.7%) ECMO患者符合DNC标准;6人接受了成功的AT. 辅助测试证实了在2名无法接受AT的患者中进行DNC.
- 另外七名患者缺少脑干反射,但由于停止维持生命治疗,没有完成DNC确定.
- AT结果与神经学检查和成像检查结果一致,与单独的辅助测试不同.
结论:
- 呼吸暂停测试可以安全有效地在选择的ECMO患者中用于DNC确定.
- 神经学检查和AT是至关重要的,而辅助测试在ECMO患者中可能不那么一致.
- 标准化协议对于在重症ECMO患者中准确确定DNC至关重要.
相关概念视频
01:30Overview of Cell Death
Cell death is an essential process where the body gets rid of old or damaged cells. Cell proliferation and death need to be balanced, as an imbalance between the two may lead to cancer or autoimmune diseases.
Cell death was observed in the early 19th century, but there was no experimental evidence to prove it. In 1842, Carl Vogt first discovered cell death in a metamorphic toad; however, it was not termed ‘cell death.’ Scientists discovered different cell death pathways only in the 20th century...
Cell death was observed in the early 19th century, but there was no experimental evidence to prove it. In 1842, Carl Vogt first discovered cell death in a metamorphic toad; however, it was not termed ‘cell death.’ Scientists discovered different cell death pathways only in the 20th century...
01:17The Extrinsic Apoptotic Pathway
The extrinsic apoptotic pathway is initiated when extracellular death-inducing signals, such as specific cytokines, activate the death receptors expressed on the cell surface. The immune cells involved in this pathway are natural killer cells (NK cells) and cytotoxic T-lymphocytes. NK cells are critical in innate immune response, while cytotoxic T-lymphocytes are associated with adaptive immune response. These cells recognize specific receptors expressed on the altered cells and activate...
01:18Autophagic Cell Death
Christian de Duve discovered “autophagy,” a process in which cellular components are engulfed by membrane-bound organelles called autophagosomes. The autophagosomes then fuse with lysosomes to digest the enclosed contents. Autophagy is generally activated in cells to prevent cell death. However, cell death is triggered when the damage is beyond repair.
Autophagy and Apoptosis
Autophagy can activate apoptosis. In normal conditions, the autophagy activating protein Beclin-1 and pro-apoptotic...
Autophagy and Apoptosis
Autophagy can activate apoptosis. In normal conditions, the autophagy activating protein Beclin-1 and pro-apoptotic...
01:16Necrosis
Necrosis is considered as an “accidental” or unexpected form of cell death that ends in cell lysis. The first noticeable mention of “necrosis” was in 1859 when Rudolf Virchow used this term to describe advanced tissue breakdown in his compilation titled “Cell Pathology”.
Morphological Manifestations of Necrosis
Necrotic cells show different types of morphological appearance depending on the type of tissue and infection. In coagulative necrosis, cells become anucleated and die, but their...
Morphological Manifestations of Necrosis
Necrotic cells show different types of morphological appearance depending on the type of tissue and infection. In coagulative necrosis, cells become anucleated and die, but their...
01:21Kubler Ross's Stages of Dying
Elisabeth Kübler-Ross significantly advanced psychology's understanding of the process of dying with her influential book, On Death and Dying (1969). She focused on studying terminally ill individuals and outlined five stages commonly experienced when coping with death: denial, anger, bargaining, depression, and acceptance.
In denial, individuals reject the reality of their condition, often thinking, "This isn't true; I feel fine," as a way to protect themselves from emotional distress. Anger...
In denial, individuals reject the reality of their condition, often thinking, "This isn't true; I feel fine," as a way to protect themselves from emotional distress. Anger...
01:16Cellular Injury IV: Necrosis
Necrosis is a form of irreversible cell death caused by severe injury such as ischemia, toxins, or trauma. Unlike programmed cell death, it is an uncontrolled, pathological process that typically provokes inflammation in surrounding tissues.Pathophysiologic ChangesNecrosis begins when cells sustain critical damage, leading to swelling of organelles, particularly mitochondria, and rapid ATP depletion. As energy levels decline, membrane ion pumps fail, leading to calcium influx and eventually,...