Discussion
donor loss to cardiac arrests, donor loss to, cardiac arrest
BRAIN DEATH, CARDIAC ARREST
In DONORS, use of an evidence-based, goal-directed checklist did not result in significant reduction in brain-dead potential donor losses to cardiac arrest. Goal-directed checklists can serve as tools to promote adherence to the existing evidence-based clinical interventions, which could translate into better quality of care and improved outcomes.There might be alternative explanations for the lack of a statistically significant effect of the checklist on brain-dead potential donor loss to cardiac arrests. First, although DONORS, to our knowledge, was the largest randomized clinical trial of donor management ever conducted, it may have been underpowered to detect a clinically relevant effect size. The point estimate decrease in brain-dead potential donor loss to cardiac arrest was 5.2% (relative risk difference, 36.5%). In previous sample size calculations, a 10% decrease in cardiac arrests among brain-dead potential donors was estimated based on the pilot study.The prespecified subgroup analysis was consistent with the main analysis, demonstrating that the effect of the intervention was the same, regardless of age, cause of brain death, or SAPS 3 scores. A sensitivity analysis showed that higher adherence to the checklist was associated with decreased cardiac arrest in brain-dead potential donors, which may have been influenced by a higher proportion of ICU beds and by the expertise acquired from previous brain-dead potential donor notifications in the most adherent sites (eTable 16 in Despite the balance in demographic characteristics between the 2 groups, there was an imbalance in meeting physiological goals at baseline. This finding may be expected in open-label cluster studies as an effect of the implementation, indicating that eligible intervention sites may have instituted clinical measures even before they were formally included.