Out of hospital cardiac arrest and uncontrolled donation after circulatory death in a tertiary cardiac arrest center

Lazzeri, Chiara; Bonizzoli, Manuela; Franci, Andrea; Cianchi, Giovanni; Batacchi, Stefano; Ciapetti, Marco; Fulceri, Giorgio Enzo; Rugna, Mario; Peris, Adriano

doi:10.1097/mej.0000000000000652

Cited by 24 publications

(24 citation statements)

References 20 publications

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“…This is a significant finding since patients with cardiac arrest prehospitally otherwise might not routinely be recognised as potential donors. Our findings are in line with other studies that suggest that there is an unrecognised donor potential in out-of-hospital cardiac arrests [15][16][17][18][19][20][21]. We concur with these suggestions.…”

Section: Prehospital Presentation Of Patients That Later Became Organ...supporting

confidence: 93%

An increased potential for organ donors may be found among patients with out-of-hospital cardiac arrest

Rasmussen

Moen

Milling

et al. 2022

Scand J Trauma Resusc Emerg Med

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Introduction A prehospital system where obvious futile cases may be terminated prehospitally by physicians may reduce unethical treatment of dying patients. Withholding treatment in futile cases may seem ethically sound but may keep dying patients from becoming organ donors. The objective of this study was to characterise the prehospital patients who underwent organ donation. The aim was to alert prehospital physicians to a potential for an increase in the organ donor pool by considering continued treatment even in some prehospital patients with obvious fatal lesions or illness. Methods This is a retrospective register-based study from the Region of Southern Denmark. The prehospital medical records from patients who underwent organ donation after prehospital care from 1st of January 2016–31st of December 2020 were screened for inclusion. The outcome measures were prehospital diagnosis, vital parameters, and critical interventions. Results In the five year period, one-hundred-and-fifty-one patients were entered into a donation process in the health region following prehospital care. Sixteen patients were excluded due to limitations in data availability. Of the 135 patients included, 36.3% had a stroke. 36.7% of these patients were intubated prehospitally. 15.6% had subarachnoideal haemorrhage. 66.7% of these were intubated prehospitally. 10.4% suffered from head trauma. 64.3% of these patients were intubated at the scene. In 21.5% of the patients, the prehospitally assigned tentative diagnosis was missing or included a diverse spectrum of medical and surgical emergencies. Twenty-two patients (16.3%) were resuscitated from cardiac arrest. 81.8% were intubated at the scene. Conclusion The majority of the patients who became organ donors presented prehospitally with intracranial pathology. However, 30% of the patients that later underwent an organ donation process had other prehospital diagnoses. Among these, one patient in six had out-of-hospital cardiac arrest. Termination of treatment in patients with cardiac arrest is not uncommon in physician-manned prehospital emergency medical systems. An organ donation process cannot be initiated prehospitally but can be shut down if treatment is withheld or terminated. We contend that there is a potential for enlarging the donor pool if the decision processes in out-of-hospital cardiac arrest include considerations concerning future procurement of organ donors.

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Section: Prehospital Presentation Of Patients That Later Became Organ...supporting

confidence: 93%

An increased potential for organ donors may be found among patients with out-of-hospital cardiac arrest

Rasmussen

Moen

Milling

et al. 2022

Scand J Trauma Resusc Emerg Med

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show abstract

“…DCD presently results in approximately 2.1 organs transplanted per donor, translating to 10.8 quality-adjusted life-years (QALYs) gained [ 19 – 21 ]. This presently constitutes half of all deceased organ donors in the United Kingdom [ 2 ] and is estimated to supply 61% of all donated organs in the United States [ 5 , 17 , 22 ]. DCDs can be categorized according to the modified Maastricht criteria into either controlled DCD (cDCD) where organ donation follows planned withdrawal of life support or uncontrolled DCD (uDCD) where donation follows unplanned circulatory death after unsuccessful cardiopulmonary resuscitation attempts [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

“…In the hospital setting, the progressive adoption of extracorporeal cardiopulmonary resuscitation (ECPR) characterized by the use of extracorporeal membrane oxygenation (ECMO) during CPR not only serves to optimize the outcomes of OHCA patients but may also become a bridging intervention towards uDCD for OHCAs who do not survive [ 27 ]. These advancements allow for prolonged organ viability despite cardiac death and position uDCD as a potential source of transplant organs [ 2 , 22 , 28 ]. This study aims to explore the potential national numbers for uDCD amongst OHCA cases using Singapore as a case study and ascertain the influence of ECPR on potential OHCA survivors.…”

Section: Introductionmentioning

confidence: 99%

Assessing unrealised potential for organ donation after out-of-hospital cardiac arrest

Tan

Latiff

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background Organ donation after brain death is the standard practice in many countries. Rates are low globally. This study explores the potential national number of candidates for uncontrolled donations after cardiac death (uDCD) amongst out-of-hospital cardiac arrest (OHCA) patients and the influence of extracorporeal cardiopulmonary resuscitation (ECPR) on the candidacy of these potential organ donors using Singapore as a case study. Methods Using Singapore data from the Pan-Asian Resuscitation Outcomes Study, we identified all non-traumatic OHCA cases from 2010 to 2016. Four established criteria for identifying uDCD candidates (Madrid, San Carlos Madrid, Maastricht and Paris) were retrospectively applied onto the population. Within these four groups, a condensed ECPR eligibility criteria was employed and thereafter, an estimated ECPR survival rate was applied, extrapolating for possible neurologically intact survivors had ECPR been administered. Results 12,546 OHCA cases (64.8% male, mean age 65.2 years old) qualified for analysis. The estimated number of OHCA patients who were eligible for uDCD ranged from 4.3 to 19.6%. The final projected percentage of potential uDCD donors readjusted for ECPR survivors was 4.2% (Paris criteria worst-case scenario, n = 532) to 19.4% of all OHCA cases (Maastricht criteria best-case scenario, n = 2428), for an estimated 14.3 to 65.4 uDCD donors per million population per year (pmp/year). Conclusions In Singapore case study, we demonstrated the potential numbers of candidates for uDCD among resuscitated OHCA cases. This sizeable pool of potential donors demonstrates the potential for an uDCD program to expand the organ donor pool. A small proportion of these patients might however survive had they been administered ECPR. Further research into the factors influencing local organ and patient outcomes following uDCD and ECPR is indicated.

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“…Current TOR rules are formulated based only on the patient's own prognosis. There has been recent interest in the possible role of OHCA patients in whom resuscitation was terminated on grounds of futility to widen the pool of potential organ donors [25,26 ▪ ,27,28]. As the criteria for uDCD from OHCA gain clarity, these may influence future iterations of TOR rules [29].…”

Section: Who To Transportmentioning

confidence: 99%

Transportation during and after cardiac arrest: who, when, how and where?

Ong

2021

Current Opinion in Critical Care

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Purpose of reviewOut-of-hospital cardiac arrest (OHCA) is the most devastating and time-critical medical emergency. Survival after OHCA requires an integrated system of care, of which transport by emergency medical services is an integral component. The transport system serves to commence and ensure uninterrupted high-quality resuscitation in suitable patients who would benefit, terminate resuscitation in those that do not, provide critical interventions, as well as convey patients to the next appropriate venue of care. We review recent evidence surrounding contemporary issues in the transport of OHCA, relating to who, where, when and how to transport these patients. Recent findingsWe examine the clinical and systems-related evidence behind issues including: contemporary approaches to field termination of resuscitation in patients in whom continued resuscitation and transport to hospital would be medically futile, OHCA patients and organ donation, on-scene versus intra-transport resuscitation, significance of response time, intra-transport interventions (mechanical chest compression, targeted temperature management, ECMO-facilitated cardiopulmonary resuscitation), OHCA in high-rise locations and cardiac arrest centers. We highlight gaps in current knowledge and areas of active research.

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Out of hospital cardiac arrest and uncontrolled donation after circulatory death in a tertiary cardiac arrest center

Cited by 24 publications

References 20 publications

An increased potential for organ donors may be found among patients with out-of-hospital cardiac arrest

An increased potential for organ donors may be found among patients with out-of-hospital cardiac arrest

Assessing unrealised potential for organ donation after out-of-hospital cardiac arrest

Transportation during and after cardiac arrest: who, when, how and where?

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