hardinparamedic: [www.learningradiology.com image 383x390]That looks pretty dead to me. Your brain is not coming back from no blood flow above the level of C2, dude.
draypresct: Catastrophic brain injury or other illness such as endstage musculoskeletal disease, pulmonary disease or high spinal cord injury.
draypresct: believe the article was a bit misleading, though. They talk about wait times without a heart beat of 75 seconds to 10 minutes, then state that people have come back after 5 minutes without a heartbeat with CPR. The problem I have is that I think that the people who have responded to CPR after 5 minutes typically had very lowered temperature (e.g. fished out of a frozen lake) and no other severe injuries.
draypresct: While wait-times and other standard may vary from hospital to hospital, they're limiting the choice to people the treating physician (not the transplant team) have decided have "no expectation of meaningful survival".
hardinparamedic: Speaking from practical experience, the majority of non-traumatic resuscitation with return of spontaneous circulation (ROSC), which occurs in the United States is either in people who have had bystander or HCP initiated CPR from the moment of collapse, or who were found down with an unknown duration of arrest (certainly any longer than five minutes) and were successfully resuscitated with drug therapy and defibrillation/cardioversion. The problem is, while the survival with a Cerebral Performance Category of 1 or 2 is about 33% in the first category, most in the second do not survive to discharge, or if so have profound neurological disability or secondary organ dysfunction from the cardiac arrest. After 72 hours of therapeutic hypothermia, if they have no meaningful reflexes, a flat EEG, and even if they have a CT Angiogram which shows no blood flow above the neck, they're dead. Their heart just hasn't gotten the message yet. There is little to no hope of a meaningful recovery beyond having a pulse.
hardinparamedic: In the United States, the transplant/organ donation team is prohibited by law from intervening in the care of a patient until the determination of brain death is made
hardinparamedic: In most places, we have a problem with them doing too much past the point of medical futility, not too little.
F42: in 2005, the guidelines for declaring death were changed, so that more organs could be donated and procured.That is absolutely terrifying.
F42: That is absolutely terrifying.
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