Tordoff Claire C, Bodenham Andrew R
Department of Anaesthesia, Leeds Teaching Hospital NHS Trust, Leeds, UK.
Department of Anaesthesia and Intensive Care Medicine, Leeds General Infirmary, Leeds, UK.
J Intensive Care Soc. 2016 May;17(2):97-102. doi: 10.1177/1751143715613796. Epub 2015 Nov 25.
We conducted a prospective observational study on 100 consecutive patients admitted to intensive care units at Leeds General Infirmary following out-of-hospital cardiac arrest. In the non-survivors, we reviewed their potential for organ donation via donation after circulatory death. Out of the 100 patients, 53 did not survive to hospital discharge. Out of these non-survivors, 13 died very suddenly within the intensive care unit and 3 other patients subsequently died in a general ward following discharge from the intensive care unit. One patient became brainstem dead, with out-of-hospital cardiac arrest secondary to a subarachnoid haemorrhage, rather than a primary cardiac cause. This patient went on to donate via the brain death mode. The remaining 36 patients had treatment withdrawn in the intensive care unit. Of these, 29 were referred to the transplant team for potential donation after circulatory death, and 14 were deemed to be medically suitable for organ donation. However, the families of only seven agreed to proceed with the donation process. Of these seven, only one went on to donate, primarily because the majority did not die within the 3-h window for acceptable warm ischaemia. In this series, the potential for donation after circulatory death following out-of-hospital cardiac arrest was limited. We would suggest an open dialogue between intensive care unit staff and transplant teams about the realistic potential for organ donation in each case. When clinicians believe it is unlikely that donation after circulatory death will proceed due to a failure to die within the pre-requisite time, then not starting with the donation after circulatory death process should be seriously considered.
我们对利兹总医院重症监护病房收治的100例院外心脏骤停后连续入院的患者进行了一项前瞻性观察研究。对于未存活患者，我们评估了其通过循环死亡后器官捐献进行器官捐赠的可能性。100例患者中，53例未存活至出院。在这些未存活患者中，13例在重症监护病房内突然死亡，另外3例在从重症监护病房出院后于普通病房死亡。1例患者因蛛网膜下腔出血继发院外心脏骤停，而非原发性心脏病因，导致脑干死亡。该患者通过脑死亡模式进行了器官捐献。其余36例患者在重症监护病房停止了治疗。其中，29例被转介至移植团队，评估循环死亡后潜在的器官捐献可能性，14例被认为在医学上适合器官捐献。然而，只有7例患者的家属同意进行捐献流程。在这7例中，只有1例最终进行了捐献，主要原因是大多数患者未在可接受的热缺血3小时窗口期内死亡。在本系列研究中，院外心脏骤停后循环死亡后的器官捐献可能性有限。我们建议重症监护病房工作人员与移植团队就每例患者器官捐献的实际可能性进行开放对话。当临床医生认为由于未能在规定时间内死亡，循环死亡后器官捐献不太可能进行时，应认真考虑不启动循环死亡后器官捐献流程。
