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Teleneurology-enabled determination of death by neurologic criteria after cardiac arrest or severe neurologic injury

M. Matiello, A.C. Turner, J. Estrada, C.M. Whitney, B.T. Kitch, P.T. Lee, U.M. Girkar, R. Palacios, P. Singla, L.H. Schwamm

Objective
To determine whether providing teleneurology (TN) consultations aiding in determination of death by neurologic criteria (DNC) to a bedside intensivist is feasible and whether timely access and expert input increase the quality of the DNC examination and identification of potential organ donors, we reviewed retrospective data related to outcomes of such consultations.
Methods
Between November 2017 and March 2019, TN consults were requested for sequential comatose patients in the intensive care unit (ICU). We recorded patients’ demographic information, causes leading to coma or suspected DNC, and the results of TN consultations. We obtained data on the number of referrals to the organ bank and number of organ donors.
Results
Ninety-nine consults were performed with a median time from request to start of the consult of 20.2 minutes (interquartile range 5.4–65.3 minutes). Eighty consults were requested for determination of prognosis, whereas 19 consults were requested for supervision of the DNC examination. In 1 of 80 (1.2%) prognostication consults, the patient was determined by the neurologist to require assessment of DNC and was found to meet DNC criteria; determination of DNC occurred in 11 of the 19 (57.9%) consultations for a supervised DNCexamination. In a comparison of the pre-TN (94 months) and post-TN (17 months) periods, there was 2.56-fold increase in the proportion of patients meeting DNC criteria who were medically suitable for donation (pre-TN 8.9% vs post-TN 21.1%, p = 0.02) and a 2.12-fold increase in the proportion of donors (pre-TN 6.14% vs post-TN 13.1%, p = 0.14).
Conclusions
It is feasible to perform TN consultations for patients with severe neurologic damage and to allow expert supervision for DNC examination. Having a teleneurologist as part of the ICU assessment team helped differentiate severe neurologic deficits from DNC and was associated with increase in organ donation.


Keywords: Telemedicina, Tele-neurología, Diagnóstico de muerte cerebral


Resumen divulgativo:

Los retrasos en la declaración de defunción por criterios neurológicos dan lugar a la pérdida de potenciales donaciones de órganos. En este estudio se muestra que utilizando Tele-neurología para la declaración de defunción en remoto se duplica el número de donaciones de órganos efectivas, para el mismo número de pacientes transferidos para posible donación.


Neurology Volumen: 96 Número: 15 Páginas: e1999-e2005

Índice de impacto JCR y cuartil WoS: 8.770 - Q1 (2019)

Referencia DOI: DOI icon 10.1212/WNL.0000000000011751

Publicado en papel: Abril 2021.

Publicado on-line: Febrero 2021.



Cita:
M. Matiello, A.C. Turner, J. Estrada, C.M. Whitney, B.T. Kitch, P.T. Lee, U.M. Girkar, R. Palacios, P. Singla, L.H. Schwamm. Teleneurology-enabled determination of death by neurologic criteria after cardiac arrest or severe neurologic injury. Neurology. Abril 2021. [Online: Febrero 2021]


    Líneas de investigación:
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