Establishing when cerebral cortical activity stops relative to circulatory arrest during the dying process will enhance trust in donation after circulatory determination of death. We used continuous electroencephalography and arterial blood pressure monitoring prior to withdrawal of life sustaining measures and for 30 min following circulatory arrest to explore the temporal relationship between cessation of cerebral cortical activity and circulatory arrest. Qualitative and quantitative EEG analyses were completed. Among 140 screened patients, 52 were eligible, 15 were enrolled, 11 completed the full study, and 8 (3 female, median age 68 years) were included in the analysis. Across participants, EEG activity stopped at a median of 78 (Q1 = −387, Q3 = 111) seconds before circulatory arrest. Following withdrawal of life sustaining measures there was a progressive reduction in electroencephalographic amplitude (p = .002), spectral power (p = .008), and coherence (p = .003). Prospective recording of cerebral cortical activity in imminently dying patients is feasible. Our results from this small cohort suggest that cerebral cortical activity does not persist after circulatory arrest. Confirmation of these findings in a larger multicenter study are needed to help promote stakeholder trust in donation after circulatory determination of death.

中文翻译：

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危重患者撤除生命维持措施后大脑皮层活动

在死亡过程中确定大脑皮层活动何时停止与循环停止相关，将增强循环确定死亡后捐赠的信任度。我们在撤除生命维持措施之前和停循环后 30 分钟使用连续脑电图和动脉血压监测，以探索大脑皮层活动停止与停循环之间的时间关系。完成了定性和定量脑电图分析。在 140 名接受筛查的患者中，52 名符合条件，15 名入组，11 名完成了整个研究，8 名（3 名女性，中位年龄 68 岁）被纳入分析。在所有参与者中，脑电图活动在循环停止前的中位数 78 秒（Q1 = −387，Q3 = 111）停止。p  = .002)、光谱功率 ( p  = .008) 和相干性 ( p  = .003)。对即将死亡的患者大脑皮层活动进行前瞻性记录是可行的。我们从这个小队列中得出的结果表明，大脑皮层活动在循环停止后不会持续存在。需要在更大规模的多中心研究中确认这些发现，以帮助提高利益相关者对血液循环确定死亡后捐赠的信任。