Organ donation in cardiac arrest patients treated with extracorporeal CPR: A single centre observational study. (September 2017) - Casadio, Maria Chiara
Abstract: Aim of the study: In a consecutive cohort of cardiac arrest (CA) treated with extracorporeal cardiopulmonary resuscitation (eCPR), we describe the incidence of brain death (BD), the eligibility for organ donation and the short-term follow-up of the transplanted organs. Methods: All refractory in- and out-of-hospital CA admitted to our Cardiac Intensive Care Unit between January 2011 and September 2016 treated with eCPR were enrolled in the study. Results: 112 CA patients received eCPR. 82 (73.2%) died in hospital, 25 BD (22.3%) and 57 for other causes (50.9%). At the time of first neurological evaluation after rewarming, variables related to evolution to BD were a lower GCS (3 [3-3] vs. 8 [3–11], p< 0.001), a higher level of neuron specific enolase (269.3 ± 49.4 vs. 55.2 ± 37.2 ng/ml, p < 0.001), a higher presence of EEG indices of poor outcome (84% vs. 15%, p < 0.001), absence of brainstem reflexes (p < 0.001), absence of bilateral N20 SSEPS waves (66.7% vs. 3.7%, p < 0.001). None of BD patients present a normal CT scan (at 2.5 ± 2 days), with 85% prevalence of diffuse hypoxic injury and a mean grey/white matter ratio of 1.1 ± 0.1. Rate of donation in BD patients was 56%, with 39 donated organs: 23 kidneys, 12 livers, and 4 lungs. 89.74% of the transplanted organs reached an early good functional recovery. Conclusion: In refractory CA patients treated with eCPR, the prevalence of BD is high. This population has a high potential for considering organ donation. Donated organs have a good outcome.