Resumption of Cardiac Activity

This prospective observational study (DePPaRT) evaluated the incidence and timing of resumption of cardiac electrical and pulsatile activity after withdrawal of life-sustaining measures in adults across 20 ICUs in Canada, the Czech Republic, and the Netherlands. Among 631 monitored patients, clinically reported resumption of cardiac activity was observed in 5 (1%), all confirmed retrospectively via ECG and arterial waveform analysis. Independent waveform review of 480 patients revealed 67 instances (14%) of transient cardiac activity after ≥60 seconds of pulselessness, with no instances beyond 4 minutes 20 seconds. The majority of resumptions lasted a few seconds (median: 3.9 seconds), and nearly half consisted of only one cardiac cycle. No patient regained consciousness or survived. These findings affirm the physiological possibility of brief autoresuscitation but support the 5-minute observation period prior to circulatory death confirmation in organ donation protocols

This prospective observational study (DePPaRT) evaluated the incidence and timing of resumption of cardiac electrical and pulsatile activity after withdrawal of life-sustaining measures in adults across 20 ICUs in Canada, the Czech Republic, and the Netherlands. Among 631 monitored patients, clinically reported resumption of cardiac activity was observed in 5 (1%), all confirmed retrospectively via ECG and arterial waveform analysis. Independent waveform review of 480 patients revealed 67 instances (14%) of transient cardiac activity after ≥60 seconds of pulselessness, with no instances beyond 4 minutes 20 seconds. The majority of resumptions lasted a few seconds (median: 3.9 seconds), and nearly half consisted of only one cardiac cycle. No patient regained consciousness or survived. These findings affirm the physiological possibility of brief autoresuscitation but support the 5-minute observation period prior to circulatory death confirmation in organ donation protocols