School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
Cardiac Intensive Care, Department of Emergency and Intensive Care, San Gerardo Hospital, ASST-Monza, Italy.
Resuscitation. 2017 Sep;118:133-139. doi: 10.1016/j.resuscitation.2017.06.001. Epub 2017 Jun 12.
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.
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.
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.
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.
在连续接受体外心肺复苏（eCPR）治疗的心搏骤停（CA）患者队列中，我们描述了脑死亡（BD）的发生率、器官捐献的资格以及移植器官的短期随访情况。
2011 年 1 月至 2016 年 9 月期间，所有在我院心内科重症监护病房（CICU）住院且接受 eCPR 治疗的难治性院内和院外 CA 患者均纳入本研究。
共纳入 112 例 CA 患者接受 eCPR 治疗。82 例（73.2%）患者死亡，其中 25 例为 BD（22.3%），57 例为其他原因（50.9%）。复温后首次神经评估时，与进展为 BD 相关的变量包括较低的 GCS（3 [3-3] 与 8 [3-11]，p<0.001）、较高的神经元特异性烯醇化酶水平（269.3±49.4 与 55.2±37.2ng/ml，p<0.001）、较高的脑电图预后不良指数（84%与 15%，p<0.001）、脑干反射缺失（p<0.001）、双侧 N20 短潜伏期体感诱发电位（SSEPS）缺失（66.7%与 3.7%，p<0.001）。BD 患者的 CT 扫描均未见正常（2.5±2 天），弥漫性缺氧性损伤的发生率为 85%，灰白质比值平均为 1.1±0.1。BD 患者的捐赠率为 56%，共捐赠 39 个器官：23 个肾脏、12 个肝脏和 4 个肺脏。89.74%的移植器官早期功能恢复良好。
在接受 eCPR 治疗的难治性 CA 患者中，BD 的发生率较高。该人群有很高的考虑器官捐献的潜力。捐赠器官的预后良好。
