Circulatory Death
Brain death and circulatory death are both death and do not differ in type, but in the way they are determined.
Determination of circulatory death requires permanent loss of:
- Breathing
- Breath sounds
- Respiratory effort
- Circulation
>5 minute loss of:- Invasive arterial pressure
Preferred to ECG, as electrical activity may persist for several minutes. The ECG should not be monitored if an arterial line is present. - Electrical activity
If an arterial line is unavailable. - Heart sounds
- Central pulse
- Invasive arterial pressure
- Spontaneous movement
The 5 minute time requirement for circulatory death is to prevent autoresuscitation, or spontaneous resumption of cardiac activity. Almost all cases of autoresuscitation occur within 2 minutes.
The the longest recorded interval prior to autoresuscitation in a DCD circumstance was 4:20, although durations of up to 10 minutes have been recorded following CPR.
The 5 minute timeframe is chosen to minimise warm ischaemic time in DCD.
Following Circulatory Death
- Reintubation
To prevent aspiration. - No ventilation
- No cardiac support
References
- ANZICS. The Statement on Death and Organ Donation. Edition 4.1. 2021.