Early identification of potential brain death organ donors based on prediction of spontaneous respiratory arrest

Guixing Xu, Yanxia Yang, Luke Wu, Donghua Zheng


Background: This study was designed to build a Nomogarm prediction model of spontaneous respiratory arrest (SRA) in nerocritical patients within 72 hours after brain injury for early identification of potential brain death organ donors.

Methods: From October 2017 to May 2019, the neurocritical patients admitted to the First Affiliated Hospital of Sun Yat-sen University, were enrolled. The occurrence of SRA within 72 hours after brain injury was regarded as the time interest point and grouping factor, factors associated with SRA were screened by univariate and multivariate analysis, and then the Nomogarm prediction model was developed. Finally, the Nomogarm prediction model was tested in the validation set.

Results: In training set, univariate and multivariate analysis showed that the midline shift (OR=4.56, 95% 1.87-19.21), absent of ambient cistern (OR=4.83, 95% 1.35-16.34), cough reflex absence (OR=3.82, 95% 1.15-12.42), intraventricular hemorrhage (OR=3.16, 95% 1.53-14.52) and serum Na+<125mmol/L (OR=3.06, 95% 1.53-13.44) were associated with SRA within 72 hours. In the training set and validation set, the predicted C index of SRA rate within 72 hours was 0.81 (95% CI 0.76-0.85) and 0.80 (95% CI 0.75-0.83), respectively. Further statistical analysis showed that 140 points, 160 points and 170 points were dangerous cut-off points, of which 140 points, 160 points and 170 points were 30.1%, 65.6% and 93.4% associated with SRA within 72 hours, respectively.

Conclusions: Nomogram prediction model based on brain injury assessment parameters can predict the time of SRA in neurocritical patients, and can be used for early identification of potential brain death organ donors.


Brain death, Neurocritical patients, Nomogram, Prediction, Spontaneous respiration arrest

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Brain IE, National Health Commission. Criteria and practical guidance for determination of brain death in adults . Chinese Medi J. 2019 Feb 5;132(3):329.

Matis G, Birbilis T. The Glasgow Coma Scale–a brief review Past, present, future. Acta Neurol Belg. 2008 Sep 1;108(3):75-89.

Firsching R. Coma after acute head injury. Deutsches Ärzteblatt International. 2017 May;114(18):313.

Nyam TT, Ao KH, Hung SY, Shen ML, Yu TC, Kuo JR. FOUR score predicts early outcome in patients after traumatic brain injury. Neurocritic Care. 2017 Apr 1;26(2):225-31.

Brain IE, National Health Commission. Criteria and practical guidance for determination of brain death in children. Zhonghua er ke za zhi= Chines J Pediatr. 2019 May 2;57(5):331.

Faden AI. Neuropeptides and central nervous system injury: clinical implications. Arch Neurol. 1986 May 1;43(5):501-4.

Picetti E, Caspani ML, Iaccarino C, Pastorello G, Salsi P, Viaroli E, et al. Intracranial pressure monitoring after primary decompressive craniectomy in traumatic brain injury: a clinical study. Acta Neurochirurgic. 2017 Apr 1;159(4):615-22.

Esteban A, Anzueto A, Alia I, Gordo F, Apezteguia C, Palizas F, Cide D, Goldwaser R, Soto L, Bugedo G, Rodrigo C. How is mechanical ventilation employed in the intensive care unit? An international utilization review. Am J Resp Critic Care Medi. 2000 May 1;161(5):1450-8.

Haji A, Kimura S, Ohi Y. A model of the central regulatory system for cough reflex. Biolog Pharmaceut Bullet. 2013 Apr 1;36(4):501-8.

Bolser DC, Poliacek I, Jakus J, Fuller DD, Davenport PW. Neurogenesis of cough, other airway defensive behaviors and breathing: A holarchical system?. Resp Physiol Neurobiol. 2006 Jul 28;152(3):255-65.

Sharshar T, Porcher R, Siami S, Rohaut B, Bailly-Salin J, Hopkinson NS, et al. Paris-Ouest Study Group on Neurological Effect of Sedation (POSGNES) Brainstem responses can predict death and delirium in sedated patients in intensive care unit. Crit Care Med. 2011 Aug;16:1960-7.

Wijdicks EF. Brain death. Handbook Clini Neurol 2013 Jan 1;118:191-203.

Servadei MT, Nasi G, Giuliani A. Maria Cremonini, P. Cenni, D. Zappi, GS Taylor F. CT prognostic factors in acute subdural haematomas: the value of the'worst'CT scan. Br J Neurosurg. 2000 Jan 1;14(2):110-6.

Quattrocchi KB, Prasad P, Willits NH, Wagner Jr FC. Quantification of midline shift as a predictor of poor outcome following head injury. Surg Neurol. 1991 Mar 1;35(3):183-8.

Yang WS, Li Q, Li R, Liu QJ, Wang XC, Zhao LB, et al. Defining the optimal midline shift threshold to predict poor outcome in patients with supratentorial spontaneous intracerebral hemorrhage. Neurocritic care. 2018 Jun 1;28(3):314-21.

Maas MB, Francis BA, Sangha RS, Lizza BD, Liotta EM, Naidech AM. Refining prognosis for intracerebral hemorrhage by early reassessment. Cerebrovasc Dis. 2017;43(3-4):110-6.

Costa KN, Nakamura HM, Cruz LR, Miranda LS, Santos-Neto RC, Cosme SD, et al. Hyponatremia and brain injury: absence of alterations of serum brain natriuretic peptide and vasopressin. Arq Nuro-psiquiatria. 2009 Dec;67(4):1037-44.

Bartels RH, Meijer FJ, van der Hoeven H, Edwards M, Prokop M. Midline shift in relation to thickness of traumatic acute subdural hematoma predicts mortality. BMC Neurol. 2015 Dec;15(1):220.

Polterauer S, Grimm C, Hofstetter G, Concin N, Natter C, Sturdza A, et al. Nomogram prediction for overall survival of patients diagnosed with cervical cancer. Br J Cancer. 2012 Sep;107(6):918-24.

Zheng RR, Huang XW, Liu WY, Lin RR, Zheng FY, et al. Nomogram predicting overall survival in operable cervical cancer patients. Int J Gynecol Cancer. 2017 Jun 1;27(5):987-93.