• Judith L Zier and Nicole A Newman.
• Department of Critical Care, Children's Minnesota, Minneapolis, MN.
• Crit. Care Med. 2022 Feb 1; 50 (2): e183-e188.

ObjectivesTo describe the unassisted return of spontaneous circulation following withdrawal of life-sustaining treatment in a child.DesignCase report based on clinical observation and medical record review.SettingCommunity Children's Hospital.PatientTwo-year old child.InterventionsFollowing hypoxic-ischemic brain injury, the child was taken to the operating room for withdrawal of life-sustaining treatment during controlled donation after circulatory determination of death.Measurements And Main ResultsIn addition to direct observation by experienced pediatric critical care providers, the child was monitored with electrocardiography, pulse oximetry, and invasive blood pressure via femoral arterial catheter in addition to direct observation by experienced pediatric critical care providers. Unassisted return of spontaneous circulation occurred greater than 2 minutes following circulatory arrest and was accompanied by return of respiration.ConclusionsWe provide the first report of unassisted return of spontaneous circulation following withdrawal of life-sustaining treatment in a child. In our case, return of spontaneous circulation occurred in the setting of controlled donation after circulatory determination of death and was accompanied by return of respiration. Return of spontaneous circulation greater than 2 minutes following circulatory arrest in our patient indicates that 2 minutes of observation is insufficient to ensure that cessation of circulation is permanent after withdrawal of life-sustaining treatment in a child.Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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