Evidence-based checklist to delay cardiac arrest in brain-dead potential organ donors: The DONORS cluster randomized clinical trial

Página do item simplificado
dc.creatorGlauco Westphal
dc.creatorSabrina Souza da Silva
dc.creatorDaiana Barbosa da Silva
dc.creatorDaniel Sganzerla
dc.creatorAlexandre Biasi Cavalcanti
dc.creatorCristiano Augusto Franke
dc.creatorFernando Augusto Bozza
dc.creatorFlávia Ribeiro Machado
dc.creatorJoel de Andrade
dc.creatorLuciano Cesar Pontes Azevedo
dc.creatorSilvana Schneider
dc.creatorVandack Alencar Nobre Júnior
dc.creatorCaroline Cabral Robinson
dc.creatorNatalia Elis Giordani
dc.creatorCassiano Teixeira
dc.creatorAdriane Isabel Rohden
dc.creatorBruna dos Passos Gimenes
dc.creatorCátia Moreira Guterres
dc.creatorItiana Cardoso Madalena
dc.creatorLuiza Vitelo Andrighetto
dc.date.accessioned2025-02-06T20:29:08Z
dc.date.accessioned2025-09-08T23:05:31Z
dc.date.available2025-02-06T20:29:08Z
dc.date.issued2023-12
dc.format.mimetypepdf
dc.identifier.doidoi:10.1001/jamanetworkopen.2023.46901
dc.identifier.issn2574-3805
dc.identifier.urihttps://hdl.handle.net/1843/79736
dc.languageeng
dc.publisherUniversidade Federal de Minas Gerais
dc.relation.ispartofJAMA Network Open
dc.rightsAcesso Aberto
dc.subjectDoação de orgãos, tecidos, etc
dc.subjectMedicina
dc.subjectMedicina baseada em evidências
dc.titleEvidence-based checklist to delay cardiac arrest in brain-dead potential organ donors: The DONORS cluster randomized clinical trial
dc.typeArtigo de periódico
local.citation.epage14
local.citation.issue12
local.citation.spage01
local.citation.volume6
local.description.resumoImportance 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.
local.publisher.countryBrasil
local.publisher.departmentMED - DEPARTAMENTO DE CLÍNICA MÉDICA
local.publisher.initialsUFMG
local.url.externahttps://jamanetwork.com/journals/jamanetworkopen/fullarticle/2812886

Arquivos

Pacote original

Agora exibindo 1 - 1 de 1
Imagem de Miniatura
Nome:
Evidence-Based Checklist to Delay Cardiac Arrest in Brain-Dead Potential Organ Donors.pdf
Tamanho:
359.91 KB
Formato:
Adobe Portable Document Format
Baixar

Licença do pacote

Agora exibindo 1 - 1 de 1
Imagem de Miniatura
Nome:
License.txt
Tamanho:
1.99 KB
Formato:
Plain Text
Descrição:
Baixar

Coleções

Artigo de Periódico

Logo UFMG