Acute and Critical Care

Original Articles

Ethics
Comparison of factors influencing the decision to withdraw life-sustaining treatment in intensive care unit patients after implementation of the Life-Sustaining Treatment Act in Korea: Claire Junga Kim, Kyung Sook Hong, Sooyoung Cho, Jin Park; Acute Crit Care. 2024;39(2):294-303. Published online May 24, 2024; DOI: https://doi.org/10.4266/acc.2023.01130

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Abstract PDF Supplementary Material: Background
The decision to discontinue intensive care unit (ICU) treatment during the end-oflife stage has recently become a significant concern in Korea, with an observed increase in life-sustaining treatment (LST) withdrawal. There is a growing demand for evidence-based support for patients, families, and clinicians in making LST decisions. This study aimed to identify factors influencing LST decisions in ICU inpatients and to analyze their impact on healthcare utilization. Methods: We retrospectively reviewed medical records of ICU patients with neurological disorders, infectious disorders, or cancer who were treated at a single university hospital between January 1, 2019 and July 7, 2021. Factors influencing the decision to withdraw LST were compared between those who withdrew LST and those who did not. Results: Among 54,699 hospital admissions, LST was withdrawn in 550 cases (1%). Cancer was the most common diagnosis, followed by pneumonia and cerebral infarction. Among ICU inpatients, LST was withdrawn from 215 (withdrawal group). The withdrawal group was older (78 vs. 75 years, P=0.002), had longer total hospital stays (16 vs. 11 days, P<0.001), and higher ICU readmission rates than the control group. There were no significant differences in the healthcare costs of ICU stay between the two groups. Most LST decisions (86%) were made by family. Conclusions: The decisions to withdraw LST of ICU inpatients were influenced by age, readmission, and disease category. ICU costs were similar between the withdrawal and control groups. Further research is needed to tailor LST decisions in the ICU.

Cardiology
Implementation of Society for Cardiovascular Angiography and Interventions classification in patients with cardiogenic shock secondary to acute myocardial infarction in a spanish university hospital: Javier Pérez Cervera, Carlos Antonio Aranda López, Rosa Navarro Romero, Javier Corral Macías, Juan Manuel Nogales Asensio, José Ramón López Mínguez; Acute Crit Care. 2024;39(2):257-265. Published online May 13, 2024; DOI: https://doi.org/10.4266/acc.2023.01620

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Abstract PDF Supplementary Material: Background
Killip-Kimball classification has been used for estimating death risk in patients suffering acute myocardial infarction (AMI). Killip-Kimball stage IV corresponds to cardiogenic shock. However, the Society for Cardiovascular Angiography and Interventions (SCAI) classification provides a more precise tool to classify patients according to shock severity. The aim of this study was to apply this classification to a cohort of Killip IV patients and to analyze the differences in death risk estimation between the two classifications. Methods: A single-center retrospective cohort study of 100 consecutive patients hospitalized for “Killip IV AMI” between 2016 and 2023 was performed to reclassify patients according to SCAI stage. Results: Distribution of patients according to SCAI stages was B=4%, C=53%, D=27%, E=16%. Thirty-day mortality increased progressively according to these stages (B=0%, C=11.88%, D=55.56%, E=87.50%; P<0.001). The exclusive use of Killip IV stage overestimated death risk compared to SCAI C (35% vs. 11.88%, P=0.002) and underestimated it compared to SCAI D and E stages (35% vs. 55.56% and 87.50%, P=0.03 and P<0.001, respectively). Age >69 years, creatinine >1.15 mg/dl and advanced SCAI stages (SCAI D and E) were independent predictors of 30-day mortality. Mechanical circulatory support use showed an almost significant benefit in advanced SCAI stages (D and E hazard ratio, 0.45; 95% confidence interval, 0.19–1.06; P=0.058). Conclusions: SCAI classification showed superior death risk estimation compared to Killip IV. Age, creatinine levels and advanced SCAI stages were independent predictors of 30-day mortality. Mechanical circulatory support could play a beneficial role in advanced SCAI stages.

Pediatrics
Characteristics and timing of mortality in children dying in pediatric intensive care: a 5-year experience: Edin Botan, Emrah Gün, Emine Kübra Şden, Cansu Yöndem, Anar Gurbanov, Burak Balaban, Fevzi Kahveci, Hasan Özen, Hacer Uçmak, Ali Genco Gençay, Tanil Kendirli; Acute Crit Care. 2022;37(4):644-653. Published online November 11, 2022; DOI: https://doi.org/10.4266/acc.2022.00395

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Abstract PDF

Background
Pediatric intensive care units (PICUs), where children with critical illnesses are treated, require considerable manpower and technological infrastructure in order to keep children alive and free from sequelae. Methods: In this retrospective comparative cohort study, hospital records of patients aged 1 month to 18 years who died in the study PICU between January 2015 and December 2019 were reviewed. Results: A total of 2,781 critically ill children were admitted to the PICU. The mean±standard deviation age of 254 nonsurvivors was 64.34±69.48 months. The mean PICU length of stay was 17 days (range, 1–205 days), with 40 children dying early (<1 day of PICU admission). The majority of nonsurvivors (83.9%) had comorbid illnesses. Children with early mortality were more likely to have neurological findings (62.5%), hypotension (82.5%), oliguria (47.5%), acidosis (92.5%), coagulopathy (30.0%), and cardiac arrest (45.0%) and less likely to have terminal illnesses (52.5%) and chronic illnesses (75.6%). Children who died early had a higher mean age (81.8 months) and Pediatric Risk of Mortality (PRISM) III score (37). In children who died early, the first three signs during ICU admission were hypoglycemia in 68.5%, neurological symptoms in 43.5%, and acidosis in 78.3%. Sixty-seven patients needed continuous renal replacement therapy, 51 required extracorporeal membrane oxygenation support, and 10 underwent extracorporeal cardiopulmonary resuscitation. Conclusions: We found that rates of neurological findings, hypotension, oliguria, acidosis, coagulation disorder, and cardiac arrest and PRISM III scores were higher in children who died early compared to those who died later.

Citations

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Descriptive and Clinical Characteristics of Nonsurvivors in a Tertiary Pediatric Intensive Care Unit in Turkey: 6 Years of Experience
Zeynep Karakaya, Merve Boyraz, Seyma Koksal Atis, Servet Yuce, Muhterem Duyu
Journal of Pediatric Intensive Care.2023;[Epub] CrossRef
Association between mortality and critical events within 48 hours of transfer to the pediatric intensive care unit
Huan Liang, Kyle A. Carey, Priti Jani, Emily R. Gilbert, Majid Afshar, L. Nelson Sanchez-Pinto, Matthew M. Churpek, Anoop Mayampurath
Frontiers in Pediatrics.2023;[Epub] CrossRef

Review Article

Ethics
Medical Management of Brain-Dead Organ Donors: A.S.M. Tanim Anwar, Jae-myeong Lee; Acute Crit Care. 2019;34(1):14-29. Published online February 28, 2019; DOI: https://doi.org/10.4266/acc.2019.00430

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Abstract PDF

With improving healthcare services, the demand for organ transplants has been increasing daily worldwide. Deceased organ donors serve as a good alternative option to meet this demand. The first step in this process is identifying potential organ donors. Specifically, braindead patients require aggressive and intensive care from the declaration of brain death until organ retrieval. Currently, there are no specific protocols in place for this, and there are notable variations in the management strategies implemented across different transplant centers. Some transplant centers follow their own treatment protocols, whereas other countries, such as Bangladesh, do not have any protocols for potential organ donor care. In this review, we discuss how to identify brain-dead donors and describe the physiological changes that occur following brain death. We then summarize the management of brain-dead organ donors and, on the basis of a review of the literature, we propose recommendations for a treatment protocol to be developed in the future.

Citations

Citations to this article as recorded by

Diabetes Insipidus in Deceased Donors and Outcomes in Kidney Transplant Recipients
Miguel Nunez, James Gardner, Shareef Syed, Allison Webber, Jun Shoji, Timothy P. Copeland, Charles E. McCulloch, Elaine Ku, Garrett R. Roll
American Journal of Kidney Diseases.2024; 84(1): 129. CrossRef
The Association of Donor Thyroid Hormone Supplementation on Heart Transplant Recipient Survival
David Blitzer, David A. Baran, Seth Lirette, Matthew Kutcher, Asim Mohammed, Hannah Copeland, Berhane M. Worku
Journal of Cardiac Surgery.2024; 2024: 1. CrossRef
Turning Loss Into Legacy
Christine G. Westphal, Rebecca Williams, Stephanie Sommer
Journal of Hospice & Palliative Nursing.2024; 26(3): 149. CrossRef
Dialyzing Brain-Dead for Organ Procurement
Ripudaman S Munjal, Jaskaran Munjal, Gagandeep Dhillon, Venkata S Buddhavarapu, Harpreet Grewal, Pranjal Sharma, Ram K Verma, Ruth Lee, Rahul Kashyap
Cureus.2024;[Epub] CrossRef
Management of potential cardiac donors
Junho Hyun, Sang Eun Lee, Jae-Joong Kim
Clinical Transplantation and Research.2024; 38(1): 37. CrossRef
Tele-ICU enabled management of an organ donor in an under-resourced setting
Prudhvi Dasari, Maheeja Reddy, Dileep Singh Parmar, Carl Britto
BMJ Case Reports.2024; 17(4): e255348. CrossRef
Does the use of double hormone replacement therapy for trauma patient organ donors improve organ recovery for transplant
Eden M Gallegos, Tanner Reed, Paige Deville, Blake Platt, Claudia Leonardi, Lillian Bellfi, Jessica Dufrene, Saad Chaudhary, John Hunt, Lance Stuke, Patrick Greiffenstein, Jonathan Schoen, Alan Marr, Anil Paramesh, Alison A Smith
World Journal of Transplantation.2024;[Epub] CrossRef
The Clinical Outcomes of Marginal Donor Hearts: A Single Center Experience
Soo Yong Lee, Seok Hyun Kim, Min Ho Ju, Mi Hee Lim, Chee-hoon Lee, Hyung Gon Je, Ji Hoon Lim, Ga Yun Kim, Ji Soo Oh, Jin Hee Choi, Min Ku Chon, Sang Hyun Lee, Ki Won Hwang, Jeong Su Kim, Yong Hyun Park, June Hong Kim, Kook Jin Chun
Korean Circulation Journal.2023; 53(4): 254. CrossRef
Induced Coma, Death, and Organ Transplantation: A Physiologic, Genetic, and Theological Perspective
Cezar-Ivan Coliță, Denissa-Greta Olaru, Daniela Coliță, Dirk M. Hermann, Eugen Coliță, Daniela Glavan, Aurel Popa-Wagner
International Journal of Molecular Sciences.2023; 24(6): 5744. CrossRef
Donor Pericardial Interleukin and Apolipoprotein Levels May Predict the Outcome after Human Orthotopic Heart Transplantation
Éva Pállinger, Andrea Székely, Evelin Töreki, Erzsébet Zsófia Bencsáth, Balázs Szécsi, Eszter Losoncz, Máté Oleszka, Tivadar Hüttl, Annamária Kosztin, Edit I. Buzas, Tamás Radovits, Béla Merkely
International Journal of Molecular Sciences.2023; 24(7): 6780. CrossRef
Intervenciones de enfermería en procuración de órganos de personas adultas con muerte encefálica: Revisión sistemática
Teresa de Jesús Solís-López , Josefina Gallegos-Martínez
Revista de Enfermería Neurológica.2023;[Epub] CrossRef
A Conceptual Framework for Evaluating National Organ Donation and Transplantation Programs
Charlotte Johnston-Webber, Jasmine Mah, Simon Streit, Apostolos Prionas, George Wharton, Elias Mossialos, Vassilios Papalois
Transplant International.2023;[Epub] CrossRef
Anesthetic Considerations of Organ Procurement After Brain and Cardiac Death: A Narrative Review
Michael B Brown, Apolonia E Abramowicz, Peter J Panzica, Garret Weber
Cureus.2023;[Epub] CrossRef
Identification of patients at high risk for brain death using an automated digital screening tool: a prospective diagnostic accuracy study
Daniela Schoene, Norman Freigang, Anne Trabitzsch, Konrad Pleul, Daniel P. O. Kaiser, Martin Roessler, Simon Winzer, Christian Hugo, Albrecht Günther, Volker Puetz, Kristian Barlinn
Journal of Neurology.2023; 270(12): 5935. CrossRef
Suspected Malignant Hyperthermia in a Brain-Dead Donor During Anesthesia for Organ Procurement Surgery: A Case Report
Hoon Jung, Hyunjee Kim, Taeyoung Yu, Jinsong Yeo, Won-Jung Shin, Hyun-Su Ri, Kyung Hwa Kwak, Dong Gun Lim, Sioh Kim
Transplantation Proceedings.2023; 55(8): 1893. CrossRef
Guía clínica intervenciones de enfermería en procuración de órganos de personas adultas con muerte encefálica
Teresa de Jesús Solís-López, Josefina Gallegos-Martínez
Revista de Enfermería Neurológica.2023; 22(2): 84. CrossRef
Facilitators and barriers in the donor family interview process from the perspective of hospital staff: a cross-sectional study
Seyed Mohammad Reza Nejatollahi, Yazdan Abdolmohammadi, Sepideh Ahmadi, Arman Hasanzade, Fatemeh Hosseini, Arshia Mohseni, Shadi Shafaghi, Mojtaba Mokhber Dezfuli, Fariba Ghorbani
Korean Journal of Transplantation.2023; 37(4): 241. CrossRef
Deceased Organ Transplantation in Bangladesh: The Dynamics of Bioethics, Religion and Culture
Md. Sanwar Siraj
HEC Forum.2022; 34(2): 139. CrossRef
Specialized Donor Care Facility Model and Advances in Management of Thoracic Organ Donors
Amit Bery, Gary Marklin, Akinobu Itoh, Daniel Kreisel, Tsuyoshi Takahashi, Bryan F. Meyers, Ruben Nava, Benjamin D. Kozower, Hailey Shepherd, G. Alexander Patterson, Varun Puri
The Annals of Thoracic Surgery.2022; 113(6): 1778. CrossRef
Nursing Diagnosis for Potential Organ Donors: Accuracy Study
Luciana Nabinger Menna Barreto, Éder Marques Cabral, Marina Raffin Buffon, Juliana Elenice Pereira Mauro, Lisiane Pruinelli, Miriam de Abreu Almeida
Clinical Nursing Research.2022; 31(1): 60. CrossRef
Proteomics, brain death, and organ transplantation
Jamie E. Jeon, Mingyao Liu
The Journal of Heart and Lung Transplantation.2022; 41(3): 325. CrossRef
Evaluation of donor heart for transplantation
Robert Tatum, Alexandros Briasoulis, Vakhtang Tchantchaleishvili, H. Todd Massey
Heart Failure Reviews.2022; 27(5): 1819. CrossRef
Evaluación de la Terapia de Preservación de los Donadores en Muerte Encefálica guiada por Metas Terapéuticas de donadores en el Hospital de Especialidades ''Dr. Antonio Fraga Mouret'' del Centro Médico Nacional ''La Raza''
José Enrique Abarca-Romero, Bertha Angélica García-García, Andrea Lucía Maya-Rivera
Revista Mexicana de Trasplantes.2022; 11(1): 20. CrossRef
Centralized Organ Recovery and Reconditioning Centers
Amit Bery, Aadil Ali, Marcelo Cypel, Daniel Kreisel
Thoracic Surgery Clinics.2022; 32(2): 167. CrossRef
Organ donation and the medicolegal aspects: A process analysis study of the Indian States - Observational study
Ishwarya Thyagarajan, Hemal Kanvinde, Sunil Shroff, MuneetKaur Sahi
Indian Journal of Transplantation.2022; 16(2): 184. CrossRef
Costs related to obtaining organs for transplantation: A systematic review
Aline Moraes da Silva, Marcos Antonio Ferreira Júnior, Andréia Insabralde de Queiroz Cardoso, Maria Lucia Ivo, Jéssica Prince Fontes Almeida, Rayane Dayara Souza Melo
Transplantation Reviews.2022; 36(4): 100724. CrossRef
Peritransplant Cardiometabolic and Mitochondrial Function: The Missing Piece in Donor Heart Dysfunction and Graft Failure
Matthew A. Wells, Louise E. See Hoe, Lisa C. Heather, Peter Molenaar, Jacky Y. Suen, Jason Peart, David McGiffin, John F. Fraser
Transplantation.2021; 105(3): 496. CrossRef
Hormones to the Rescue: Ameliorating Acute Lung Inflammation After Donor Brain Death
Anna Valujskikh
Transplantation.2021; 105(4): 697. CrossRef
17β-Estradiol Treatment Protects Lungs Against Brain Death Effects in Female Rat Donor
Fernanda Yamamoto Ricardo-da-Silva, Roberto Armstrong, Marina Vidal-dos-Santos, Cristiano de Jesus Correia, Raphael dos Santos Coutinho e Silva, Lucas Ferreira da Anunciação, Luiz Felipe Pinho Moreira, Hendrik Gerrit Derk Leuvenink, Ana Cristina Breithaup
Transplantation.2021; 105(4): 775. CrossRef
Inflammatory responses in lungs from donation after brain death: Mechanisms and potential therapeutic targets
Aaron Wong, Mingyao Liu
The Journal of Heart and Lung Transplantation.2021; 40(9): 890. CrossRef
Hypothalamic-pituitary axis disorder – “the puppet master” of multiple organ dysfunction in brain-dead patients
Bianca-Liana Grigorescu
The Journal of Critical Care Medicine.2021; 7(3): 157. CrossRef
Kadavra Donörden Organ Nakli Oranlarını Arttırmada Hemşirenin Sorumlukları: Sahada Neler Yapabiliriz?
Tuğba Nur ÖDEN, Fatma DEMİR KORKMAZ
Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi.2021; 8(3): 558. CrossRef
A translational rat model for ex vivo lung perfusion of pre-injured lungs after brain death
Judith E. van Zanden, Henri G. D. Leuvenink, Erik A. M. Verschuuren, Michiel E. Erasmus, Maximilia C. Hottenrott, Frank JMF Dor
PLOS ONE.2021; 16(12): e0260705. CrossRef
Public opinion and legislations related to brain death, circulatory death and organ donation
Marwan H. Othman, Anirban Dutta, Daniel Kondziella
Journal of the Neurological Sciences.2020; 413: 116800. CrossRef
Donor Heart Utilization in Korea
In-Cheol Kim, Jong-Chan Youn, Sang Eun Lee, Sung-Ho Jung, Jae-Joong Kim
International Journal of Heart Failure.2020; 2(4): 254. CrossRef
Effects of Gut Metabolites and Microbiota in Healthy and Marginal Livers Submitted to Surgery
Marc Micó-Carnero, Carlos Rojano-Alfonso, Ana Isabel Álvarez-Mercado, Jordi Gracia-Sancho, Araní Casillas-Ramírez, Carmen Peralta
International Journal of Molecular Sciences.2020; 22(1): 44. CrossRef
Brain Death and Management of Potential Organ Donor: An Indian Perspective

Indian Journal of Critical Care Medicine.2019; 23(S2): 151. CrossRef

Original Articles

Ethics
Transcultural Adaptation and Validation of Quality of Dying and Death Questionnaire in Medical Intensive Care Units in South Korea: Jun Yeun Cho, Jinwoo Lee, Sang-Min Lee, Ju-Hee Park, Junghyun Kim, Youlim Kim, Sang Hoon Lee, Jong Sun Park, Young-Jae Cho, Ho Il Yoon, Jae Ho Lee, Choon-Taek Lee, Yeon Joo Lee; Acute Crit Care. 2018;33(2):95-101. Published online May 31, 2018; DOI: https://doi.org/10.4266/acc.2017.00612

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Abstract PDF Supplementary Material

Background
Providing palliative care to dying patients in the intensive care unit (ICU) has recently received much attention. Evaluating the quality of dying and death (QODD) is important for appropriate comfort care in the ICU. This study aimed to validate the Korean version of the QODD questionnaire.
Methods
This study included decedents in the ICUs of three tertiary teaching hospitals and one secondary hospital from June 2016 to May 2017. ICU staff members were asked to complete the translated QODD questionnaire and the visual analogue scale (VAS) questionnaire within 48 hours of patient death. The validation process consisted of evaluating construct validity, internal consistency, and interrater reliability.
Results
We obtained 416 completed questionnaires describing 255 decedents. The QODD score was positively correlated with the 100-VAS score (Pearson correlation coefficient, 0.348; P<0.001). An evaluation of the internal consistency presented favorable results (calculated Cronbach’s alpha if a given item exceeded 0.8 in all items). The interrater reliability revealed no concordance between doctors and nurses.
Conclusions
The QODD questionnaire was successfully translated and validated in Korean medical ICUs. We hope further studies that use this valuable instrument will be conducted in Korea.

Citations

Citations to this article as recorded by

Factors associated with the quality of dying and death and missed nursing care
Shahin Gahramani, Mokhtar Mahmoudi, Nouri, Sina Valiee
International Journal of Palliative Nursing.2024; 30(4): 190. CrossRef
A systematic review of instruments measuring the quality of dying and death in Asian countries
Shuo Xu, Yue Fang, Hanzhang Chen, Kang Sun, Chen Zhang, Yang Liu
Quality of Life Research.2023; 32(7): 1831. CrossRef
Translation, Validity and Internal Consistency of the Quality of Dying and Death Questionnaire for Brazilian families of patients that died from cancer: a cross-sectional and methodological study
Bianca Sakamoto Ribeiro Paiva, Talita Caroline de Oliveira Valentino, Mirella Mingardi, Marco Antonio de Oliveira, Julia Onishi Franco, Michelle Couto Salerno, Helena Palocci, Tais Cruz de Melo, Carlos Eduardo Paiva
Sao Paulo Medical Journal.2023;[Epub] CrossRef
Russian nurses’ readiness for transcultural care of palliative patients
Nataliya Kasimovskaya, Natalia Geraskina, Elena Fomina, Svetlana Ivleva, Maria Krivetskaya, Nina Ulianova, Marina Zhosan
BMC Palliative Care.2023;[Epub] CrossRef
Change in perception of the quality of death in the intensive care unit by healthcare workers associated with the implementation of the “well-dying law”
Ye Jin Lee, Soyeon Ahn, Jun Yeun Cho, Tae Yun Park, Seo Young Yun, Junghyun Kim, Jee-Min Kim, Jinwoo Lee, Sang-Min Lee, Jong Sun Park, Young-Jae Cho, Ho Il Yoon, Jae Ho Lee, Choon-Taek Lee, Yeon Joo Lee
Intensive Care Medicine.2022; 48(3): 281. CrossRef
Factors Associated with Quality of Dying and Death in Korean Intensive Care Units: Perceptions of Nurses
Haeyoung Lee, Seung-Hye Choi
Healthcare.2021; 9(1): 40. CrossRef
Validation of the Chinese Version of the Quality of Dying and Death Questionnaire for Family Members of ICU Patients
Xing-ping Han, Xu Mei, Jing Zhang, Ting-ting Zhang, Ai-ni Yin, Fang Qiu, Meng-jie Liu
Journal of Pain and Symptom Management.2021; 62(3): 599. CrossRef
Validation of the Quality of Dying and Death Questionnaire among the Chinese populations
Ying Wang, Mandong Liu, Wallace Chi Ho Chan, Jing Zhou, Iris Chi
Palliative and Supportive Care.2021; 19(6): 694. CrossRef
The quality of dying and death for patients in intensive care units: a single center pilot study
Yanghwan Choi, Myoungrin Park, Da Hyun Kang, Jooseon Lee, Jae Young Moon, Heejoon Ahn
Acute and Critical Care.2019; 34(3): 192. CrossRef
Factors Associated With Quality of Death in Korean ICUs As Perceived by Medical Staff: A Multicenter Cross-Sectional Survey
Jun Yeun Cho, Ju-Hee Park, Junghyun Kim, Jinwoo Lee, Jong Sun Park, Young-Jae Cho, Ho Il Yoon, Sang-Min Lee, Jae-Ho Lee, Choon-Taek Lee, Yeon Joo Lee
Critical Care Medicine.2019; 47(9): 1208. CrossRef

Hematology
Recombinant Activated Factor VII as a Second Line Treatment for Postpartum Hemorrhage: Soon Chang Park, Seok Ran Yeom, Sang Kyoon Han, Young Mo Jo, Hyung Bin Kim; Korean J Crit Care Med. 2017;32(4):333-339. Published online November 30, 2017; DOI: https://doi.org/10.4266/kjccm.2016.00787

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Abstract PDF

Background
Severe or massive postpartum hemorrhage (PPH) has remained a leading cause of maternal mortality for decades across the world and it results in critical obstetric complications. Recombinant activated factor VII (rFVIIa) has emerged as a gold standard adjunctive hemostatic agent for the treatment of life-threatening PPH refractory to conventional therapies although it remains off-licensed for use in PPH. We studied the effects of rFVIIa on coagulopathy, transfusion volume, prognosis, severity change in Korean PPH patients.
Methods
A retrospective review of medical records between December 2008 and March 2011 indicating use of rFVIIa in severe PPH was performed. We compared age, rFVIIa treatment, transfusion volume, and Sequential Organ Failure Assessment (SOFA) score at the time of arrival in the emergency department and after 24 hours for patients whose SOFA score was 8 points or higher.
Results
Fifteen women with SOFA score of 8 and above participated in this study and eight received rFVIIa administration whereas seven did not. Patients’ mean age was 31.7 ± 7.5 years. There was no statistically significant difference in initial and post-24 hours SOFA scores between patients administered rFVIIa or not. The change in SOFA score between initial presentation and after 24 hours was significantly reduced after rFVIIa administration (P = 0.016).
Conclusions
This analysis aimed to support that the administration of rFVIIa can reduce the severity of life-threatening PPH in patients. A rapid decision regarding the administration of rFVIIa is needed for a more favorable outcome in severe PPH patients for whom there is no effective standard treatment.

Citations

Citations to this article as recorded by

Role of recombinant factor VIIa in the clinical management of severe postpartum hemorrhage: consensus among European experts
D. Surbek, J. Blatný, M. Wielgos, N. Acs, H. Edwards, O. Erez, J. L. Bartha, H. Madar, F. J. Mercier, D. Schlembach, G. C. Di Renzo
The Journal of Maternal-Fetal & Neonatal Medicine.2024;[Epub] CrossRef
Efficacy and Safety Analyses of Recombinant Factor VIIa in Severe Post-Partum Hemorrhage
Camila Caram-Deelder, Hellen McKinnon Edwards, Jarmila A. Zdanowicz, Thomas van den Akker, Camilla Birkegård, Jan Blatný, Johanna G. van der Bom, Giuseppe Colucci, Derek van Duuren, Nan van Geloven, Dacia D. C. A. Henriquez, Marian Knight, Lars Korsholm,
Journal of Clinical Medicine.2024; 13(9): 2656. CrossRef
Coagulation management and transfusion in massive postpartum hemorrhage
Christina Massoth, Manuel Wenk, Patrick Meybohm, Peter Kranke
Current Opinion in Anaesthesiology.2023; 36(3): 281. CrossRef
Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care
Sibylle Kietaibl, Aamer Ahmed, Arash Afshari, Pierre Albaladejo, Cesar Aldecoa, Giedrius Barauskas, Edoardo De Robertis, David Faraoni, Daniela C. Filipescu, Dietmar Fries, Anne Godier, Thorsten Haas, Matthias Jacob, Marcus D. Lancé, Juan V. Llau, Jens Me
European Journal of Anaesthesiology.2023; 40(4): 226. CrossRef

Case Reports

Neurology/Cardiology
Extracorporeal Membrane Oxygenation for the Support of a Potential Organ Donor with a Fatal Brain Injury before Brain Death Determination: Sung Wook Chang, Sun Han, Jung Ho Ko, Jae-Wook Ryu; Korean J Crit Care Med. 2016;31(2):169-172. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.169

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Abstract PDF

The shortage of available organ donors is a significant problem and various efforts have been made to avoid the loss of organ donors. Among these, extracorporeal membrane oxygenation (ECMO) has been introduced to help support and manage potential donors. Many traumatic brain injury patients have healthy organs that might be eligible for donation for transplantation. However, the condition of a donor with a fatal brain injury may rapidly deteriorate prior to brain death determination; this frequently results in the loss of eligible donors. Here, we report the use of venoarterial ECMO to support a potential donor with a fatal brain injury before brain death determination, and thereby preserve donor organs. The patient successfully donated his liver and kidneys after brain death determination.

Citations

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Outcomes of Extracorporeal Membrane Oxygenation in Children: An 11-Year Single-Center Experience in Korea
Hongsun Kim, Ji-Hyuk Yang, Yang Hyun Cho, Tae-Gook Jun, Kiick Sung, Woosik Han
The Korean Journal of Thoracic and Cardiovascular Surgery.2017; 50(5): 317. CrossRef

Toxicology
Management of Cyanide Intoxication with Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy: Jin Park, Seung-Yeob Lee, Hyun-Sik Choi, Yoon Hee Choi, Young-Joo Lee; Korean J Crit Care Med. 2015;30(3):218-221. Published online August 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.3.218

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Abstract PDF

Cyanide intoxication results in severe metabolic acidosis and catastrophic prognosis with conventional treatment. Indications of extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) are expanding to poisoning cases. A 50-year-old male patient arrived in the emergency room due to mental change after ingestion of cyanide as a suicide attempt 30 minutes prior. He was comatose, and brain stem reflexes were absent. Initial laboratory analysis demonstrated severe metabolic acidosis with increased lactic acid of 25 mM/L. Shock and acidosis were not corrected despite a large amount of fluid resuscitation with high-dose norepinephrine and continuous renal replacement therapy. We decided to apply ECMO and CRRT to allow time for stabilization of hemodynamic status. After administration of antidote infusion, although the patient had the potential to progress to brain death status, vital signs were improved with correction of acidosis. We considered the evaluation for organ donation. We report a male patient who showed typical cyanide intoxication as lethal metabolic acidosis and cardiac impairment, and the patient recovered after antidote administration during vital organ support through ECMO and CRRT.

Citations

Citations to this article as recorded by

Cyanogenic glycoside amygdalin influences functions of human osteoblasts in vitro
Radoslav Omelka, Veronika Kovacova, Vladimira Mondockova, Birgit Grosskopf, Adriana Kolesarova, Monika Martiniakova
Journal of Environmental Science and Health, Part B.2021; 56(2): 109. CrossRef

Cardiology
Use of Extracorporeal Membrane Oxygenation for Optimal Organ Donation: Jeong Hoon Yang, Yang Hyun Cho, Chi Ryang Chung, Kyeongman Jeon, Chi Min Park, Gee Young Suh; Korean J Crit Care Med. 2014;29(3):194-196. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.194

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Abstract PDF

We report a case of extracorporeal membrane oxygenation (ECMO) support for donor organ preservation in a brain-dead patient following out-of-hospital cardiac arrest. A 43-year-old male patient was referred to the emergency department after an out-of-hospital cardiac arrest caused by ventricular fibrillation. Spontaneous circulation was restored after 8 minutes of cardiopulmonary resuscitation. ECMO was implemented because of hemodynamic deterioration. The patient then underwent coronary angiography and was implanted with a drug-eluting stent because of occlusion at the proximal portion of the right coronary artery. After 144 hours, brain death was established, and ECMO support for optimal oxygen delivery was sustained until organ retrieval after consent for donation was received from the family. Liver and kidneys were successfully transplanted to three recipients, respectively.

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Extracorporeal Membrane Oxygenation for the Support of a Potential Organ Donor with a Fatal Brain Injury before Brain Death Determination
Sung Wook Chang, Sun Han, Jung Ho Ko, Jae-Wook Ryu
Korean Journal of Critical Care Medicine.2016; 31(2): 169. CrossRef
The Use of Extracorporeal Circulation in Suspected Brain Dead Organ Donors with Cardiopulmonary Collapse
Hyun Lee, Yang Hyun Cho, Kiick Sung, Jeong Hoon Yang, Chi Ryang Chung, Kyeongman Jeon, Gee Young Suh
Journal of Korean Medical Science.2015; 30(12): 1911. CrossRef

Successful Management of Potential Non-Heart-Beating Donor with Extracorporeal Membrane Oxygenation: A Case Report: Young Hwan Kim, Gui Yun Sohn, Yooun Joong Jung, Kyu Hyouck Kyoung, Suk Kyung Hong; Korean J Crit Care Med. 2012;27(4):279-282.; DOI: https://doi.org/10.4266/kjccm.2012.27.4.279

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Abstract PDF

Hemodynamics of a brain-dead donor can change rapidly during management. It frequently leads to loss of the donor or deterioration of organ functions. Various efforts have been made not to lose potential donors. Extracorporeal membrane oxygenation (ECMO) and non-heart-beating donation (NHBD) are good examples of such efforts. A 47 year-old woman with a history of hypertension, diabetes mellitus and atrial fibrillation was diagnosed with cerebral infarction and hemorrhage. Cardiopulmonary resuscitation was performed three times before transfer to our hospital. Her family agreed to organ donation. ECMO was applied due to her unstable vital signs, which made the first declaration of brain death possible. However, considering the deteriorating vital signs and expected cardiac arrest, it was decided to switch to NHBD under the family's consent. All life-support devices including ECMO were turned off in the operation room. After cardiac death was declared, the harvesting of liver and kidneys was performed with perfusion through an ECMO catheter. The liver and kidneys were successfully transplanted to three recipients.

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Extra-Corporeal Membrane Oxygenation Cadaver Donors: What about Tissues Used as Allografts?
Gregorio Marchiori, Matteo Berni, Giorgio Cassiolas, Leonardo Vivarelli, Nicola Francesco Lopomo, Milena Fini, Dante Dallari, Marco Govoni
Membranes.2021; 11(7): 545. CrossRef
The Use of Extracorporeal Circulation in Suspected Brain Dead Organ Donors with Cardiopulmonary Collapse
Hyun Lee, Yang Hyun Cho, Kiick Sung, Jeong Hoon Yang, Chi Ryang Chung, Kyeongman Jeon, Gee Young Suh
Journal of Korean Medical Science.2015; 30(12): 1911. CrossRef
Successful Transplantation of Organs from a Donor with Bacterial Meningitis Caused byStreptococcus pneumonia- A Case Report -
Eunjung Park, Sang-Cheon Choi, Youngjoo Lee, Yoonseok Jung, Younggi Min
Korean Journal of Critical Care Medicine.2013; 28(2): 115. CrossRef

Original Article

Thyroid Hormonal Changes in Brain Death Donors: Jae Myeong Lee, Young Joo Lee; Korean J Crit Care Med. 2011;26(3):157-161.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.157

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Abstract PDF

BACKGROUND
We analyzed thyroid hormone values in brain death patients to determine the need for thyroid hormone replacement therapy.
METHODS
We analyzed 111 brain death donors (77 males and 34 females, mean age, 41.1 years (range; 8 months -72 years) in Ajou University Hospital from 2000 to 2010.
RESULTS
The mean values of thyroid hormones were T3; 72.5 ng/dl (normal range [NR] 60-181 ng/dl), T4; 5.0 microg/dl (NR 4.5-10.9 microg/dl), free T4 1.0 ng/dl (NR 0.8-1.5 ng/dl), and TSH 1.5 microIU/ml (NR 0.35-5.5 microIU/ml), respectively. However, the values of T4 (correlation coefficient -0.264, p = 0.005), free T4 (correlation coefficient -0.305, p = 0.001) and TSH (correlation -0.206, p = 0.031) significantly decreased based on the increase of interval from the brain death-inducing event to the evaluation time (hereafter, interval). The patients with greater than 8 days of interval (N = 30) showed significantly low thyroid hormone values compared to patients with less than 8 days of interval (N = 81); T3 (70.3 ng/dl vs. 77.0 ng/dl, p = 0.242), T4 (4.7 ng/dl vs. 5.3 ng/dl, p = 0.015), free T4 (0.8 ng/dl vs. 1.2 ng/dl, p = 0.006) and TSH (1.0 microIU/ml vs. 2.0 microIU/ml, p = 0.000), respectively.
CONCLUSIONS
As the intervals from the brain death-inducing events increased, all thyroid hormone values of brain death donors except T3 significantly decreased. Therefore, we recommend that careful consideration should be given to the interval from brain death-inducing event for the evaluation of thyroid hormone status of brain death patients.

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Identification of Hemodynamic Risk Factors for Apnea Test Failure During Brain Death Determination
Jin Joo Kim, Eun Young Kim
Transplantation Proceedings.2019; 51(6): 1655. CrossRef

Case Report

Successful Heart Transplantation after Dobutamine, Glucose-insulin-potassium, and Hormone Therapy in a Hemodynamically Unstable Cadaveric Heart Donor: A Case Report: So Yeon Kim, Shin Ok Koh, Young Chul Yoo, Ha Kyoung Kim, Tae Jin Yun, Eun Ji Chang, Sungwon Na; Korean J Crit Care Med. 2010;25(2):89-92.; DOI: https://doi.org/10.4266/kjccm.2010.25.2.89

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Abstract PDF

The major limitation to heart transplantation is the shortage of donor organs. In order to increase the cardiac donor pool, it is important to maintain stable hemodynamics and closely monitor cardiac function in cadaveric organ donors or potent donors. Recently, management of a potential cardiac donor pool has focused on aggressive hemodynamic management protocols and dobutamine stress echocardiography. In our case, management with low dose dobutamine, glucose-insulin-potassium (GIK), and hormone therapy reversed heart failure following brain death and the heart was successfully transplanted. We suggest that aggressive hemodynamic management with low-dose dobutamine, GIK, and hormone therapy can result in the recruitment of more cadaveric hearts in marginal conditions.

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Predisposing Hemodynamic Factors Associated with a Failed Apnea Test during Brain Death Determination
Eun Young Kim, Ji Hyun Kim
The Korean Journal of Critical Care Medicine.2016; 31(3): 236. CrossRef

Original Article

A Survey of Patients Who Were Admitted for Life-Sustaining Therapy in Nationwide Medical Institutions: Jong Myon Bae, Joo Young Gong, Jae Ran Lee, Dae Seog Heo, Younsuck Koh; Korean J Crit Care Med. 2010;25(1):16-20.; DOI: https://doi.org/10.4266/kjccm.2010.25.1.16

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Abstract PDF

BACKGROUND
The study focused on figuring out the present status and distribution of the underlying diseases of Korean terminally ill patients (TIP) who were on life-support care (LSC) by conducting a nationwide health care survey.
METHODS
The authors of this study requested that the 308 nationwide hospitals that operate intensive care units answer a questionnaire that asked about the number of admitted TIPs and their underlying diseases at 12 Am, 22 July, 2009. The proportion of TIPs among all the admitted patients and the percentages of the TIP's underlying diseases were calculated.
RESULTS
In a total of 83.1% of the eligible hospitals responded, the proportion of TIP was 1.6 of 100 admitted patients. Terminal cancer was the leading underlying disease in the TIPs (42.4%). Five % of the patients on LSC were brain dead. More TIPs were admitted in the national/public or university hospitals than in the private or non-university hospitals.
CONCLUSIONS
Futile treatment seems to be administered to the TIPs in Korean hospitals. The quality of terminal care in Korean hospitals should be improved by the application of socially acceptable LSC guidelines. Timely government health plans, including hospice care, to improve the quality of palliative care should be launched and maintained.

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Korean Journal of Critical Care Medicine.2014; 29(3): 160. CrossRef
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Dong Soon Kim, AeYoung So, Kyung-Sook Lee, Jung Sook Choi
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Dae Seog Heo
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Korean Journal of Critical Care Medicine.2012; 27(1): 16. CrossRef
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