Summary
Between March 2017 and April 2019, TN consults were requested for sequential ICU comatose patients. We recorded patients’ demographic information, causes leading to coma or suspected death by neurologic criteria and the results of TN consultations. We obtained data regarding the number of referrals to organ bank and number of organ donors.
Original Article
Teleneurology-Enabled Determination of Death by Neurologic Criteria After Cardiac Arrest or Severe Neurologic Injury
Neurology
Marcelo Matiello, Ashby C. Turner, Juan Estrada, Cynthia M. Whitney, Barrett T. Kitch, Patrick T. Lee, Uma Girkar, View ORCID ProfileRafael Palacios, View ORCID ProfilePooja Singla, View ORCID ProfileLee Schwamm
Abstract
Objective: To determine if providing teleneurology (TN) consultations aiding in determination of death by neurologic criteria (DNC) to a bedside intensivist is feasible; and whether timely access and expert input increases the quality of the DNC exam and identification of potential organ donors, we reviewed retrospective data related to outcomes of such consultations.
Methods: Between March 2017 and April 2019, TN consults were requested for sequential ICU comatose patients. We recorded patients’ demographic information, causes leading to coma or suspected death by neurologic criteria and the results of TN consultations. We obtained data regarding the number of referrals to organ bank and number of organ donors.
Results: Ninety-nine consults were performed with a median time from request to start of the consult of 20.2 minutes (IQR 5.4-65.3 min). Eighty consults were requested for determination of prognosis, whereas 19 consults were requested for supervision of the DNC examination. In 1 of 80 (1.2%) prognostication consults, the patient was determined by the neurologist to require assessment of DNC and was found to meet DNC criteria; determination of DNC occurred in 11 of the 19 (57.9%) consultations for supervised DNC exam. When comparing pre (94 months) and post teleneurology (17 months) periods, there was 2.56-fold increase in the proportion of patients meeting DNC criteria who were medically suitable for donation (pre-TN 8.9% vs. post-TN 21.1%, p=0.02) and a 2.12-fold increase in the proportion of donors (pre-TN 6.14%, vs. post-TN 13.1%, p=0.14).
Conclusions: It is feasible to perform TN consultations for patients with severe neurologic damage and to allow expert supervision for DNC examination. Having a teleneurologist as part of the ICU assessment team helped differentiate severe neurologic deficits from DNC and was associated with increase in organ donation.
