Yee et al identified factors predictive of death within 60 minutes of withdrawing life support in a neurocritical patient. A patient who dies within 60 munutes of withdrawing life support often makes a better organ donor than if death takes longer. The authors are from the Mayo Clinic.
Patient selection: irreversible coma in the neurologic ICU
Parameters:
(1) corneal reflex
(2) cough reflex
(3) motor response
(4) oxygenation index (OI)
Parameter |
Finding |
Points |
corneal reflex |
present |
0 |
|
absent |
1 |
cough reflex |
present |
0 |
|
absent |
1 |
motor response |
extensor |
0 |
|
absent |
1 |
oxygenation index |
<= 4.2 |
0 |
|
> 4.2 |
1 |
number of predictors present =
= SUM(points for all 4 parameters)
Interpretation:
• minimum number of predictors: 0
• maximum number of predictors: 4
• The probability of death within 60 minutes increases with the number of predictors present.
• In Figure 1 on page 1384 the possible combinations (15 of 16) for the various predictors are given with the respective probabilities.
Number of Predictors |
Probability of Death Within 60 Minutes |
1 |
65-76% |
2 |
72-84% |
3 |
85-92% |
4 |
93% |
Specialty: Critical Care, Emergency Medicine
ICD-10: ,