Citation

Chawla LS, Terek M, Junker C, Akst S, Yoon B, Brasha-Mitchell E, Seneff MG. Death Stud. 2017; 41(6): 385-392.

Affiliation

c Department of Anesthesiology and Critical Care Medicine , George Washington University Medical Center , Washington , DC.

Copyright

(Copyright © 2017, Informa - Taylor and Francis Group)

DOI

10.1080/07481187.2017.1287138

PMID

28145850

Abstract

BACKGROUND: Neuromonitoring devices to assess level of sedation are now used commonly in many hospital settings. We previously reported that electro-encephalic-graphic (EEG) spikes frequently occurred after the time of death in patients being neuro-monitored at the time of cessation of circulation. In addition to our initial report, end of life electrical surges (ELES) have been subsequently documented in animal and human studies by other investigators. The frequency, character, intensity, and significance of ELES are unknown. Some have proposed that patients should not be declared dead for purposes of organ donation prior to the occurrence of an ELES. If clinical practice were altered in order to await the presence of an ELES, there could be detrimental consequences to donated organs and their recipients. In order to better further characterize ELES, we retrospectively assessed the frequency and nature of ELES in serial patients.

METHODS: To better document ELES, we collected neuromonitoring, demographic, and clinical data on consecutive patients who expired while being actively monitored as part of their standard palliative care. These data were retrospectively collected when available as a convenience sample.

RESULTS: We assessed 35 patients of which 7 were clinically confirmed as brain dead. None of the brain dead patients displayed an ELES. 13 of the 28 patients (46.4%) of the remaining patients exhibited an ELES. The ELES observed were demonstrated to have high frequency EEG signal. The mean peak amplitude of ELES as measured by Patient State Index(tm) (PSI) was 58.5 ± 25.7.

CONCLUSIONS: In this preliminary assessment, we found that ELES are common in critically ill patients who succumb. The exact cause and significance of ELES remain unknown; further study is warranted.

Language: en