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Tipo:	Artigo de Periódico
Título:	Evidence-based checklist to delay cardiac arrest in brain-dead potential organ donors: The DONORS cluster randomized clinical trial
Autor(es):	Glauco Westphal Sabrina Souza da Silva Daiana Barbosa da Silva Daniel Sganzerla Alexandre Biasi Cavalcanti Cristiano Augusto Franke Fernando Augusto Bozza Flávia Ribeiro Machado Joel de Andrade Luciano Cesar Pontes Azevedo Silvana Schneider Vandack Alencar Nobre Júnior Caroline Cabral Robinson Natalia Elis Giordani Cassiano Teixeira Adriane Isabel Rohden Bruna dos Passos Gimenes Cátia Moreira Guterres Itiana Cardoso Madalena Luiza Vitelo Andrighetto
Resumen:	Importance The effectiveness of goal-directed care to reduce loss of brain-dead potential donors to cardiac arrest is unclear. Objective To evaluate the effectiveness of an evidence-based, goal-directed checklist in the clinical management of brain-dead potential donors in the intensive care unit (ICU). Design, Setting, and Participants The Donation Network to Optimize Organ Recovery Study (DONORS) was an open-label, parallel-group cluster randomized clinical trial in Brazil. Enrollment and follow-up were conducted from June 20, 2017, to November 30, 2019. Hospital ICUs that reported 10 or more brain deaths in the previous 2 years were included. Consecutive brain-dead potential donors in the ICU aged 14 to 90 years with a condition consistent with brain death after the first clinical examination were enrolled. Participants were randomized to either the intervention group or the control group. The intention-to-treat data analysis was conducted from June 15 to August 30, 2020. Interventions Hospital staff in the intervention group were instructed to administer to brain-dead potential donors in the intervention group an evidence-based checklist with 13 clinical goals and 14 corresponding actions to guide care, every 6 hours, from study enrollment to organ retrieval. The control group provided or received usual care. Main Outcomes and Measures The primary outcome was loss of brain-dead potential donors to cardiac arrest at the individual level. A prespecified sensitivity analysis assessed the effect of adherence to the checklist in the intervention group. Results Among the 1771 brain-dead potential donors screened in 63 hospitals, 1535 were included. These patients included 673 males (59.2%) and had a median (IQR) age of 51 (36.3-62.0) years. The main cause of brain injury was stroke (877 [57.1%]), followed by trauma (485 [31.6%]). Of the 63 hospitals, 31 (49.2%) were assigned to the intervention group (743 [48.4%] brain-dead potential donors) and 32 (50.8%) to the control group (792 [51.6%] brain-dead potential donors). Seventy potential donors (9.4%) at intervention hospitals and 117 (14.8%) at control hospitals met the primary outcome (risk ratio [RR], 0.70; 95% CI, 0.46-1.08; P = .11). The primary outcome rate was lower in those with adherence higher than 79.0% than in the control group (5.3% vs 14.8%; RR, 0.41; 95% CI, 0.22-0.78; P = .006). Conclusions and Relevance This cluster randomized clinical trial was inconclusive in determining whether the overall use of an evidence-based, goal-directed checklist reduced brain-dead potential donor loss to cardiac arrest. The findings suggest that use of such a checklist has limited effectiveness without adherence to the actions recommended in this checklist.
Asunto:	Doação de orgãos, tecidos, etc Medicina Medicina baseada em evidências
Idioma:	eng
País:	Brasil
Editor:	Universidade Federal de Minas Gerais
Sigla da Institución:	UFMG
Departamento:	MED - DEPARTAMENTO DE CLÍNICA MÉDICA
Tipo de acceso:	Acesso Aberto
Identificador DOI:	doi:10.1001/jamanetworkopen.2023.46901
URI:	http://hdl.handle.net/1843/79736
Fecha del documento:	dic-2023
metadata.dc.url.externa:	https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2812886
metadata.dc.relation.ispartof:	JAMA Network Open
Aparece en las colecciones:	Artigo de Periódico

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