• Canadian Critical Care Trials Group
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  • Canadian Critical Care Trials Group
    The Canadian Critical Care Trials Group (CCCTG) is a national organization of more than 300 individuals with research interests in the management of the critically ill patient.
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Programs

Principal Investigator(s)

Sonny Dhanani

Coordinator(s)

Amanda van Beinum

Status

Enrolling

DDePICt - Determination of Death Practices in Intensive Care Resarch Program

Phase I - Literature Reviews. Narrative review of: a) the standards and practice of the determination of death after cardiac arrest and published in Journal of Intensive Care Medicine. Systematic review on autoresuscitation published in Critical Care Medicine.

Phase II – Survey of Canadian adult and pediatric intensive care physicians to determine current understanding and practice of determination of death after cardiac arrest. Published in Critical Care Medicine.

Phase IIIa – Pilot Multicentre Prospective Observational Study of the determinants of death after cardiac arrest after WLST in the ICU using non-invasive and invasive monitoring technology to assess acceptability and feasibility for a larger study. 41 patients were enrolled from 5 Canadian sites (1 pediatric 4 adult). Received CIHR, PSI and CHEO RI funding ($163K). Manuscript submitted to Critical Care Medicine.

Phase IV – Multicentre Prospective Observational Study to elucidate the natural history of cessation of physiological function after the removal of life support in those expected to die. Both non-invasive and invasive monitoring technology will be used in Canadian adult and pediatric intensive care units. Funding secured ($780K) as part of the Canadian National Transplant Research Program.

Death Prediction and Physiology After Removal of Therapy (DePPaRT)
Background: Major barriers to implementing DCD practice remain.
Research Question and Hypothesis:
1. After the heart stops, its electrical activity may continue for some time but that autoresuscitation will not occur beyond 5 minutes.
2. A novel prediction tool for time to death will improve identification of patients eligible for DCD.
Setting: 10-14 (8-10 adult and 2 pediatric) Canadian ICU’s.
Study Participants: 500 patients (adults and pediatric) over a 3-year period with 3 groups: DCD donors, DCD eligible but do not donate, DCD non-eligible
Study Design: Multicentre, prospective observational study
Methodology: The monitoring devices will be left in place 10 mins prior to the time of WLST to 30 minutes after death.  Waveform data will be uploaded and transferred. Demographics and other data will also be collected.
Sample size: 500 participants. For the qualitative study, we will conduct interviews with 60 family members of patients from 4 centers.
Analysis: Demographic and physiological characteristics of the study groups will take place. Descriptive statistics will be used to analyze  primary outcomes.  Multivariate analysis will be used to develop a prediction tool for death following WLST.  Qualitative analysis of the q the end of life experiences will be analyzed using the standard qualitative method of conventional content analysis
Importance of Study: Further data on physiological changes that occur during the dying process will address concerns regarding whether DCD donors are in fact dead prior to donation, increasing confidence in and better implementation of DCD practice.

Phase V – Guideline Development and Implementation of standards for the determination of death for the purposes of organ donation after cardiac death (DCD).

For more information about the DDePICt program, visit the program's website.

Co-Investigators

Jennifer Chandler, Andrew Seely, Laura Hornby, Maureen Meade, Jason Shahin, Amanda van Beinum

(non CCCTG Members)
Jane Chamber-Evans, Dale Gardiner, Teneille Gofton, Greg Knoll, Tim Ramsay, Sam Shemie, Bryan Young

Participating Centers

Children’s Hospital of Eastern Ontario (Coordinating Centre)
St. Michael’s Hospital
Queen Elizabeth II Health Sciences Centre
Foothills Medical Centre
Hospital for Sick Children
McGill University Health Center
Sunnybrook Hospital
Vancouver General Hospital
University of Alberta Hospital
The Ottawa Hospital
Royal Columbian Hospital
London Health Sciences Centre

Charles University, Prague
Nottingham University Hospitals