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Su Y, Chen W, Zhang Y, Fan L, Liu G, Tian F, Huang H, Cui L, Gao C, Su Y, Hu Y, Chen H. To Accelerate the Process of Brain Death Determination in China Through the Strategy and Practice of Establishing Demonstration Hospitals. Neurocrit Care 2024; 41:100-108. [PMID: 38182918 DOI: 10.1007/s12028-023-01908-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/29/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Our objective was to explore whether a brain death determination (BDD) strategy with demonstration hospitals can accelerate the process of BDD in China. METHODS We proposed the construction standards for the BDD quality control demonstration hospitals (BDDHs). The quality and quantity of BDD cases were then analyzed. RESULTS A total of 107 BDDHs were established from 2013 to 2022 covering 29 provinces, autonomous regions, and municipalities under jurisdiction of the central government of the Chinese mainland (except Qinghai and Tibet). A total of 1,948 professional and technical personnel from these 107 BDDHs received training in BDD, 107 quality control personnel were trained in the quality control management of BDD, and 1,293 instruments for electroencephalography, short-latency somatosensory evoked potential recordings, and transcranial Doppler imaging were provided for BDD. A total of 6,735 BDD cases were submitted to the quality control center. Among the nine quality control indicators for BDD in these cases, the implementation rate, completion rate, and coincidence rate of apnea testing increased the most, reaching 99%. CONCLUSIONS The strategy of constructing BDDHs to promote BDD is feasible and reliable. Ensuring quality and quantity is a fundamental element for the rapid and orderly popularization of BDD in China.
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Affiliation(s)
- Yingying Su
- Department of Neurology, Neurocritical Care Unit, Xuanwu Hospital, Capital Medical University, Beijing, 10053, China.
- Brain Death Determination Quality Control Demonstration Hospital Alliance, Beijing, China.
| | - Weibi Chen
- Department of Neurology, Neurocritical Care Unit, Xuanwu Hospital, Capital Medical University, Beijing, 10053, China
- Brain Death Determination Quality Control Demonstration Hospital Alliance, Beijing, China
| | - Yan Zhang
- Department of Neurology, Neurocritical Care Unit, Xuanwu Hospital, Capital Medical University, Beijing, 10053, China
- Brain Death Determination Quality Control Demonstration Hospital Alliance, Beijing, China
| | - Linlin Fan
- Department of Neurology, Neurocritical Care Unit, Xuanwu Hospital, Capital Medical University, Beijing, 10053, China
- Brain Death Determination Quality Control Demonstration Hospital Alliance, Beijing, China
| | - Gang Liu
- Department of Neurology, Neurocritical Care Unit, Xuanwu Hospital, Capital Medical University, Beijing, 10053, China
- Brain Death Determination Quality Control Demonstration Hospital Alliance, Beijing, China
| | - Fei Tian
- Department of Neurology, Neurocritical Care Unit, Xuanwu Hospital, Capital Medical University, Beijing, 10053, China
- Brain Death Determination Quality Control Demonstration Hospital Alliance, Beijing, China
| | - Huijin Huang
- Department of Neurology, Neurocritical Care Unit, Xuanwu Hospital, Capital Medical University, Beijing, 10053, China
- Brain Death Determination Quality Control Demonstration Hospital Alliance, Beijing, China
| | - Lili Cui
- Department of Neurology, Neurocritical Care Unit, Xuanwu Hospital, Capital Medical University, Beijing, 10053, China
- Brain Death Determination Quality Control Demonstration Hospital Alliance, Beijing, China
| | - Caiyun Gao
- Brain Death Determination Quality Control Demonstration Hospital Alliance, Beijing, China
- Department of Neurology, Neurocritical Care Unit, Inner Mongolia People's Hospital, Huhhot, China
| | - Yuying Su
- Brain Death Determination Quality Control Demonstration Hospital Alliance, Beijing, China
- Department of Neurology, Neurocritical Care Unit, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yajuan Hu
- Brain Death Determination Quality Control Demonstration Hospital Alliance, Beijing, China
- Department of Neurology, Neurocritical Care Unit, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hongbo Chen
- Department of Neurology, Liangxiang Hospital of Beijing Fangshan District, Beijing, China
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Fan L, Li W, Du R, Hu Y, Li W, Zhu W, Zhang L, Su Y. Apnea Testing Practice to Increase Baseline PaCO 2 and Frequency of Blood Gas Analyses. J Cardiothorac Vasc Anesth 2024; 38:1006-1010. [PMID: 38246819 DOI: 10.1053/j.jvca.2023.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE To study the influence of the initial partial pressure of carbon dioxide (PaCO2) and frequency of blood gas analyses on the positivity rate and safety of apnea testing (AT). DESIGN A prospective multicenter cohort study. SETTING Seven teaching hospitals. PARTICIPANTS A total of 55 patients who underwent AT. INTERVENTIONS Patients were divided into 2 groups according to their initial PaCO2-the experimental group (≥40 mmHg, 27 patients) and the control group (<40 mmHg, 28 patients). Blood gas analysis was performed at 3, 5, and 8 minutes, and vital signs were taken. AT results and complications were compared between the groups. RESULTS The initial PaCO2 of the experimental group was 42.8 ± 2.2 mmHg v 36.4 ± 2.9 mmHg in the controls. The AT positivity rate was 100%. The experimental group needed less time to reach the target PaCO2 than the control group (4.07 ± 1.27 minutes v 5.68 ± 2.06 minutes; p = 0.001). Twenty-six patients (96.3%) in the experimental group reached the target PaCO2 in 5 minutes v 17 in the control group (60.7%) (p = 0.001). Seven patients (12.7%) were unable to complete 8-minute disconnection due to hypotension. The experimental group had a slightly lower incidence of hypotension than the control group, but there was no statistical difference (7.4% v 17.9%, p = 0.245). CONCLUSION Increasing the baseline PaCO2 and doing more blood gas analyses can significantly shorten the time needed for AT and improve the AT positivity rate.
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Affiliation(s)
- Linlin Fan
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Wei Li
- Department of Neurology, Army Medical Center of PLA, Chongqing, China
| | - Ran Du
- Neurological Intensive Care Unit, First Affiliated Hospital of Anhui Medical University, Zhengzhou, China
| | - Yajuan Hu
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wenchen Li
- First Hospital of Jilin University, Changchun, China
| | - Wenhao Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Zhang
- First People's Hospital of Yunnan Province, Kunming, Yunnan Province, China
| | - Yingying Su
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China.
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