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.
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
Brain death or plan for Neurologic Determination of Death (NDD)
Injuries that anatomically preclude the use of neurologic monitoring
The study will include all patients admitted to a participating ICU who fulfil all the inclusion criteria and for whom none of the exclusion criteria exist.
Cohort
Prospective
electroencephalography (EEG)
Diagnostic test1. brain cortical activity using full scalp 2. cerebral blood flow velocity 3. during the dying process following planned withdrawal of life sustaining measures (WLSM)
Patient Accrual complete study procedures)
90 patients at all sites and an additional 18 patients at the lead site for specific tests
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.
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.
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