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Transient Return of Cardiac Activity ID'd After Pulselessness

THURSDAY, Jan. 28, 2021 -- Transient resumption of cardiac activity occurs in a proportion of patients after planned withdrawal of life-sustaining measures, according to a study published in the Jan. 28 issue of the New England Journal of Medicine.

Sonny Dhanani, M.D., from the Children's Hospital of Eastern Ontario in Ottawa, Canada, and colleagues conducted a prospective observational study of the incidence and timing of resumption of cardiac electrical and pulsatile activity among adults who died after planned withdrawal of life-sustaining measures from 20 intensive care units. A total of 631 patients were included and monitored for 30 minutes after determination of death.

The researchers found that five patients (1 percent) had clinically reported resumption of cardiac activity, respiratory movement, or both that was confirmed by waveform analysis. Sixty-seven instances with resumption of cardiac activity after a period of pulselessness were identified in 480 patients (14 percent) in a retrospective analysis of electrocardiographic and blood-pressure waveforms; these instances included the five reported by bedside clinicians. Following pulselessness, the longest duration before resumption of cardiac activity was four minutes 20 seconds. In 19 percent of the patients, the last QRS complex coincided with the last arterial pulse.

"Our analysis of clinical reports by bedside clinicians and vital-sign waveform recordings from a large international sample supports the current five-minute observation period required by most protocols and guidelines for proceeding with organ donation after circulatory determination of death," the authors write.

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