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Organ donation in cardiac arrest patients treated with extracorporeal CPR: A single centre observational study
Maria Chiara Casadio1, Anna Coppo2, Alessia Vargiolu3
1School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
Insights
Extracorporeal cardiopulmonary resuscitation (eCPR) for cardiac arrest (CA) leads to a high incidence of brain death (BD). This patient group offers significant potential for organ donation, with transplanted organs demonstrating good functional recovery.
Area of Science:
- Cardiology
- Neurology
- Transplantation Medicine
Background:
- Refractory cardiac arrest (CA) poses significant challenges in patient outcomes.
- Extracorporeal cardiopulmonary resuscitation (eCPR) is utilized for select CA patients.
- Brain death (BD) is a critical endpoint in critical care settings.
Purpose of the Study:
- To determine the incidence of brain death (BD) in patients treated with extracorporeal cardiopulmonary resuscitation (eCPR).
- To assess the eligibility and outcomes of organ donation in this patient population.
- To evaluate the short-term functional recovery of organs transplanted from BD donors post-eCPR.
Main Methods:
- A consecutive cohort of refractory in- and out-of-hospital CA patients treated with eCPR were enrolled.
- Neurological evaluations, including GCS, neuron-specific enolase levels, EEG, brainstem reflexes, and SSEP, were performed.
- Brain imaging (CT scans) and organ donation rates were analyzed.
Main Results:
- Out of 112 CA patients receiving eCPR, 25 (22.3%) met criteria for brain death (BD).
- Factors predicting BD included lower GCS, elevated neuron-specific enolase, abnormal EEG, absent brainstem reflexes, and absent N20 SSEP waves.
- Fifty-six percent of BD patients were eligible for organ donation, resulting in 39 transplanted organs (23 kidneys, 12 livers, 4 lungs) with a 89.74% early good functional recovery rate.
Conclusions:
- Refractory cardiac arrest patients undergoing eCPR exhibit a high prevalence of brain death.
- This population represents a valuable source for organ donation.
- Organs procured from these donors show promising short-term functional outcomes post-transplantation.
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±37.2ng/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±2days), 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.
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