COVID-19 pandemisinde beyin ölümü tanısı ve yönetimi

Year 2022, , 942 - 949, 30.09.2022

Ayşe Neslihan Balkaya , Asiye Demirel , Hamide Ayben Korkmaz , Buket Özyaprak , Nermin Kılıçarslan , Canan Yılmaz

https://doi.org/10.17826/cumj.1036931

Cited By: 2

Abstract

Amaç: Bu çalışma, COVID-19 pandemisi sırasında bir araştırma hastanesinde tespit edilen beyin ölümü (BÖ) ve kadavra bağışı vakalarının tanı ve yönetimindeki deneyimlerin paylaşılmasını amaçlamıştır.
Gereç ve Yöntem: 15/03/2020-15/05/2021 tarihleri arasında yoğun bakım ünitelerimizde (YBÜ) tanı alan BÖ olguları geriye dönük olarak değerlendirildi. Hastaların demografik özellikleri, birincil tanıları, yoğun bakıma kabul süreleri ve hastanede kalış süreleri analiz edildi. Klinik şüphe, tanı, beyan ve bağış veya kardiyak arrest süreleri ve gerçekleştirilen klinik yargıyı desteklemek için ek testler de değerlendirildi.
Bulgular: Çalışmaya yaş ortalaması 59.9 yıl olan %56.8'i erkek, %43.2'si kadın 37 olgu dahil edildi. YBÜ yatışlarında en sık (%54.1) tanı intrakraniyal kanama idi. Apne testleri sadece 27 hastada (%73) yapılabildi. 27 (%73) olguda ek test olarak cerebral BT-anjiyografi kullanıldı. 10 hastadan (%27) organ bağışı için aile onayı alındı ve bunların %70'i (n= 7) donör oldu. YBÜ'e yatışıyla BÖ tanısı arasındaki süre 114±92.8 (11-360) saat, klinik şüphe ile tanı arasındaki süre 32±15,1 (4-78) saat, donör olmayanlarda tanı ile kardiyak arrest arasındaki süre 24±15.2 (5-72) saat, tanı ile bağış arasındaki süre 23±7.6 (15-35) saatti.
Sonuç: COVID-19 nedeniyle yoğun bakım ünitelerinde doluluk, donör olabilecek hastaların YBÜ’ne kabulünü azaltmış, hastanemizde BÖ tespit, aile onayı ve organ bağışı sayılarında azalma olmuştur.

Keywords

beyin ölümü,, COVID-19, Donör, Organ transplantasyonu

Brain death diagnosis and management in the COVID-19 pandemic

Abstract

Purpose: This present study aimed to share experiences in the diagnosis and management of brain death (BD) and cadaveric donation cases, detected in a research hospital during the COVID-19 pandemic.
Materials and Methods: BD cases diagnosed between 15/03/2020-15/05/2021 in our intensive care units (ICU) were retrospectively evaluated. Patients’ demographic characteristics, primary diagnoses, ICU admission time, and length of hospital stay were analyzed. Clinical suspicion, diagnosis, declaration, and donation or cardiac arrest times and supplementary tests to support the clinical judgment performed were also evaluated.
Results: 37 cases, were included in the study. Intracranial hemorrhage was the most common (54.1%) diagnosis in ICU admissions. Apnea tests could be performed only in 27 patients (73%). Cerebral CT-angiography was used as a supplementarytary test in 27 (73%) cases. Family consent for organ donation was obtained from 10 patients (27%), and 70% (n= 7) of them became donors. The time between ICU admission and BD diagnosis time was 114±92.8 (11-360) hours, the time between clinical suspicion and diagnosis was 32±15.1 (4-78) hours, the time between diagnosis and cardiac arrest of non-donors was 24±15.2 (5-72) hours, and the time between diagnosis and donation was 23±7.6 (15-35) hours.
Conclusion: Occupancy in ICUs due to COVID-19 has reduced the admission of patients who may be donors to ICUs, and there has been a decrease in the number of BD detection, family approval, and organ donation in our hospital.

Keywords

Brain death, COVID-19, Donor, Organ transplantation

References

• 1. Levin A, Tonelli M, Bonvente J et al. Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy. Lancet. 2017; 390: 1888-17
• 2. Loupy A, Aubert O, Reese PP, et al. Organ procurement and transplantation during the COVID-19 pandemic. Lancet. 2020 May 23;395(10237):95-96. doi: 10.1016/S0140-6736(20)31040-0. 3. Paixão JTC, Nascimento VHN, Alves MC, et al. Analysis of brain death declaration process and its impact on organ donation in a reference trauma center. Einstein (São Paulo). 2020;18:eAO5448. doi: 10.31744/einstein_journal/2020AO5448
• 4. Sabancı P, Karasu A, Karadereler S, et al. Beyin ölümü tanısı. Sinir Sistemi Cerrahisi Dergisi. 2008;1:81-5.
• 5. Wang C, Horby PW, Hayden FG, et al. A novel coronavirus outbreak of global health concern. The Lancet. 2020; 395(10223): 470- 3
• 6. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13. doi:10.1016/S0140-6736(20)30211-7.
• 7. Angelico R, Trapani S, Manzia TM, et al. The COVID-19 outbreak in Italy: Initial implications for organ transplantation programs. Am J Transplant. 2020;20:1780-4.
• 8. Türkiye Cumhuriyeti Sağlık Bakanlığı. Potansiyel Bağışçılar için Coronavirüs Taraması. Erişim tarihi: 20/Ocak/2021. https://organ.saglik.gov.tr/AllNews.aspx?q=4V/Rsua850c21xrT4j071HUy38dyQWoNzy1FpkcjwsZtuynTX65bvLnZPVXqGaYQ
• 9. Arsava EM, Demirkaya S, Dora B, et al. Türk Nöroloji Derneği beyin ölümü tanı kılavuzları. Türk J Neurol. 2014;20:101-4.
• 10. https://www.saglik.gov.tr/TR,10528/organ-ve-doku-naklihizmetleri-yonetmeligi.html (erişim tarihi: 10.11.2021)
• 11. Dabak G, Şenbaklavacı Ö. History of Lung Transplantation. Turk Thorac J. 2016;17:71-5.
• 12. Utku T. Beyin ölümü ve organ donör bakımı. Türk Yoğun Bakım Derneği Dergisi 2007;5:61-8.
• 13. Karasu D, Yılmaz C, Karaduman İ, Çınar YS, et al. Retrospective analysis of patients with brain death. Dahili ve Cerrahi Bilimler Yoğun Bakım Dergisi. 2015;6:23-6.
• 14. Eminoğlu Ş, Özgünay ŞE. Retrospective analysis of patiens with brain death. EuRJ 2019;5(5), 847-52.
• 15. Türkiye Cumhuriyeti Sağlık Bakanlığı. Doku, Organ Nakli ve Diyaliz Hizmetleri. Bağışlar ve Bağışçılar. Erişim tarihi: 10 Ocak 2021. https://organkds.saglik.gov.tr/dss/PUBLIC/Brain_Death.aspx
• 16. Aghighi M, Mahdavi-Mazdeh M, Saberi Isfeedvajani M, et al. Brain-dead donation rate in month of Ramadan and the other months: 2005-2014. Int J Organ Transplant Med. 2017;8:165-7.
• 17. Han SY, Kim JI, Lee EW, et al. Factors associated with a family’s delay of decision for organ donation after brain death. Ann Transplant. 2017;22:17-23.
• 18. Uludağ Ö, Sabuncu Ü, Kuşderci H, et al. Organ bağışında neredeyiz? J Turk Soc Intens Care. 2016;14:86-92. 19. Battal M, Horoz A, Karatepe O, et al. Experience of research hospital in determination of brain death. Şişli Etfal Hastanesi Tıp Bülteni. 2013;47:59-62
• 20. Eira CSLD, Barros MIT, Albuquerque AMP. Organ donation: the reality of an intensive care unit in Portugal. Rev Bras Ter Intensiva. 2018;30:201-7.
• 21. Escudero D, Valentín MO, Escalante JL, et al. Intensive care practices in brain death diagnosis and organ donation. Anaesthesia. 2015;70:1130-9.
• 22. Caliskan G, Sayan A, Kilic I, et al. Has the COVID-19 Pandemic Affected Brain Death Notifications and Organ Donation Time? Exp Clin Transplant. 2021 Aug 9. doi: 10.6002/ect.2021.0090.
• 23. Greer DM, Shemie SD, Lewis A, et al. Determination of brain death/death by neurologic criteria: the World Brain Death Project. JAMA. 2020;324:1078- 97
• 24. Kirschen MP, McGowan N, Topjian A. Brain Death Evaluation in Children With Suspected or Confirmed Coronavirus Disease 2019. Pediatr Crit Care Med. 2021;22(3):318-22. doi: 10.1097/PCC.0000000000002650.
• 25. Wijdicks EFM, Varelas PN, Gronseth GS, et al. Evidence-based guideline update: determining brain death in adults: report of the quality standards subcommittee of the American academy of neurology. Neurology. 2010;74:1911–8.
• 26. Radaideh Y, Garg R, Abdalla AA, et al. Challenges in brain death determination and apnea testing for patients with COVID-19. J Stroke Cerebrovasc Dis. 2020;29:105419.
• 27. Migdady I, Rae-Grant A, Greer DM. Brain death evaluation during the pandemic. Neurology. 2020;95:693-4.
• 28. Kapoor I, Prabhakar H, Mahajan C. COVID-19 and diagnosing brain death: An ambiguity. Turk J Anaesthesiol Reanim. 2020;48:436-47.
• 29. Kıraklı C, Uçar ZZ, Anıl AB, et al. Yoğun bakım’da beyin ölümü kesin tanı süresinin kısalmasının organ bağışı oranlarına etkisi, Yoğun Bakım Derg. 2011;1:8-11.
• 30. Cuomo A, Zucker H, Dreslin S. 2020. Health Advisory: COVID-19 Guidance for Hospital Operators Regarding Visitation. New York City.
• 31. Kates OS, Fisher CE, Rakita RM, et al. Use of SARS-CoV-2-infected deceased organ donors: should we always “just say no?” Am. J. Transplant. 2020;20:1787–94.
• 32. Azzi Y, Bartash R, Scalea J, et al. COVID-19 and solid organ transplantation: A review article. Transplantation. 2021;105:37-55.
• 33. Mengi T, Şirin H, Yaka E, et al. Brain Death Diagnosis and Management in the Pandemic: Expert Opinion of the Turkish Neurological Society Neurological Intensive Care Scientific Working Group. Turkish Journal of Neurology. 2021;27:1-4.
• 34. Vargas M, Iacovazzo C, Servillo G. Additional suggestions for organ donation during COVID-19 outbreak. Transplantation. 2020;104:1984-5.
• 35. Yakar MN, Istan P, Gurkok MC, et al. Management of an organ donation process in COVID-19 pandemic: First case of Turkey. Turk J Anaesthesiol Reanim. 2020;48:244-7.