Renaudier M, Binois Y, Dumas F, Lamhaut L, Beganton F, Jost D, Charpentier J, Lesieur O, Marijon E, Jouven X, Cariou A, Bougouin W
Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France.
Paris Sudden Death Expertise Center, Paris, France.
Ann Intensive Care. 2022 Jun 6;12(1):48. doi: 10.1186/s13613-022-01023-7.
Organ shortage is a major public health issue, and patients who die after out-of-hospital cardiac arrest (OHCA) could be a valuable source of organs. Here, our objective was to identify factors associated with organ donation after brain death complicating OHCA, in unselected patients entered into a comprehensive real-life registry covering a well-defined geographic area.
We prospectively analyzed consecutive adults with OHCA who were successfully resuscitated, but died in intensive care units in the Paris region in 2011-2018. The primary outcome was organ donation after brain death. Independent risk factors were identified using logistic regression analysis. One-year graft survival was assessed using Cox and log-rank tests.
Of the 3061 included patients, 136 (4.4%) became organ donors after brain death, i.e., 28% of the patients with brain death. An interaction between admission pH and post-resuscitation shock was identified. By multivariate analysis, in patients with post-resuscitation shock, factors associated with organ donation were neurological cause of OHCA (odds ratio [OR], 14.5 [7.6-27.4], P < 0.001), higher pH (OR/0.1 increase, 1.3 [1.1-1.6], P < 0.001); older age was negatively associated with donation (OR/10-year increase, 0.7 [0.6-0.8], P < 0.001). In patients without post-resuscitation shock, the factor associated with donation was neurological cause of OHCA (OR, 6.9 [3.0-15.9], P < 0.001); higher pH (OR/0.1 increase, 0.8 [0.7-1.0], P = 0.04) and OHCA at home (OR, 0.4 [0.2-0.7], P = 0.006) were negatively associated with organ donation. One-year graft survival did not differ according to Utstein characteristics of the donor.
4% of patients who died in ICU after OHCA led to organ donation. Patients with OHCA constitute a valuable source of donated organs, and special attention should be paid to young patients with OHCA of neurological cause.
器官短缺是一个重大的公共卫生问题，院外心脏骤停（OHCA）后死亡的患者可能是宝贵的器官来源。在此，我们的目标是在纳入一个涵盖明确地理区域的综合现实生活登记系统的未经过筛选的患者中，确定与OHCA并发脑死亡后器官捐献相关的因素。
我们对2011年至2018年在巴黎地区重症监护病房成功复苏但最终死亡的连续性OHCA成年患者进行了前瞻性分析。主要结局是脑死亡后的器官捐献。使用逻辑回归分析确定独立危险因素。使用Cox和对数秩检验评估一年移植物存活率。
在纳入的3061例患者中，136例（4.4%）在脑死亡后成为器官捐献者，即脑死亡患者中的28%。确定了入院时的pH值与复苏后休克之间的相互作用。通过多变量分析，在复苏后休克的患者中，与器官捐献相关的因素包括OHCA的神经学病因（比值比[OR]，14.5[7.6 - 27.4]，P < 0.001）、较高的pH值（OR/每增加0.1，1.3[1.1 - 1.6]，P < 0.001）；年龄较大与捐献呈负相关（OR/每增加10岁，0.7[0.6 - 0.8]，P < 0.001）。在没有复苏后休克的患者中，与捐献相关的因素是OHCA的神经学病因（OR，6.9[3.0 - 15.9]，P < 0.001）；较高的pH值（OR/每增加0.1，0.8[0.7 - 1.0]，P = 0.04）和在家中发生的OHCA（OR，0.4[0.2 - 0.7]，P = 0.006）与器官捐献呈负相关。根据捐献者的Utstein特征，一年移植物存活率没有差异。
OHCA后在重症监护病房死亡的患者中有4%实现了器官捐献。OHCA患者是宝贵的器官捐献来源，应特别关注神经学病因的年轻OHCA患者。
