Neurologic Physiology After Removal of Therapy (NeuPaRT)

Study Overview
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Brief Summary
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The purpose of this study is to determine when brain function stops compared to when the heart stops by monitoring electrical brain activity in patients who are taken off life support and progress to death in the intensive care unit.

Detailed Description
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There are many Canadians who need an organ transplant and who will never get one. In the past, people could only be organ donors after being declared brain dead. The dead donor rule serves this purpose by ensuring that death determination precedes organ retrieval. In Canada, death determination occurs in one of two ways. In neurologic determination of death (NDD), death is declared upon completion of a standardized neurologic assessment that confirms permanent loss of brain activity. In donation after circulatory determination of death (DCDD), death is declared 5 minutes after circulatory arrest. By confirming permanent loss of brain activity, the current NDD process protects donors from suffering and maintains stakeholder trust. In contrast, the current DCDD process assumes, but does not explicitly confirm, permanent loss of brain activity when death is declared 5 minutes after circulatory arrest. While this assumption is rooted in a strong physiologic rationale, lack of compelling evidence regarding cessation of brain activity in humans contributes to ongoing mistrust of the DCDD process among healthcare and public stakeholders.

Official Title
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Neurologic Physiology After Removal of Therapy (NeuPaRT): Pilot Multicentre Feasibility Study

Conditions
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Determination of Death

Intervention / Treatment
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* Diagnostic Test: electroencephalography (EEG)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥ 18 years Plan for the withdrawal of life sustaining measures (WLSM) Attending physician anticipates patient will die within 24 hours of the withdrawal of life sustaining measures Patient has an indwelling arterial cannula for monitoring blood pressure Exclusion Criteria: Brain death or plan for Neurologic Determination of Death (NDD) Injuries that anatomically preclude the use of neurologic monitoring

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Diagnostic Test: electroencephalography (EEG)|brain cortical activity using full scalp cerebral blood flow velocity during the dying process following planned withdrawal of life sustaining measures (WLSM)|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient Accrual complete study procedures) | 90 patients at all sites and an additional 18 patients at the lead site for specific tests | 2022 to 2023 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Waveform Data Completeness | Adequate waveform signal that (i) spans circulatory arrest, (ii) includes data for at least 80% of the planned observation period (from the withdrawal of life sustaining measures to 30 minutes after circulatory arrest [or 5 minutes for confirmed donation after circulatory determination of death (DCDD) donors]), and (iii) has a clearly identifiable time of cessation for each signal. | 2022-2023 | 
| Time Difference Circulatory Arrest and Cessation of EEG Activity | Cerebral blood flow velocity in middle cerebral artery (when available), and cessation of event/evoked potentials (LHSC site only). See below for definition of cessation of each signal. | 2022-2023 |