Development of the Asystolic Predication Score: A tool to assist shared decision making, in DCD donation through prediction of time to asystole following withdrawal of life sustaining treatment

Abstract

The aim of this study was to develop and validate a clinical tool to calculate the probabilities of asystole following withdrawal of life-sustaining treatment (WLST) in potential donation after circulatory death (DCD) donors in the United Kingdom, which is imperative to shared decision-making. A two-stage prospective observational cohort study was undertaken in multi-centre mixed and neurological adult intensive care units in the United Kingdom. One hundred and sixty three potential DCD donors who underwent WLST were included in this study between 2010-2011. An asystole prediction-scoring (APS) tool incorporating clinical variables, assimilated to a score on the basis of derived severity was validated. Data were collected at two time points: initial referral and 60 minutes prior to WLST. Cox regression analysis determined overall probabilities of asystole following WLST. Cox regression demonstrated statistically significant (p<0.05) probabilities of asystole using the APS tool. Probabilities of asystole were produced for time points between 0 and 240 minutes. Lower scores have a low probability of asystole occurring within 180 minutes while higher scores have a high probability of asystole occurring at all time points. Potential donors with APS total scores greater than 30 all died within 180 minutes of WLST. The APS tool provides important information on the likelihood of asystole within defined time lines. This ability to predict time lines could be used by clinicians in decision-making in referring potential DCD donors, and through sharing probabilities of donation occurring with family members thereby facilitating shared decision-making to underpin informed consent.

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ORCID for T. Long-Sutehall: orcid.org/0000-0002-6661-9215

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