Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
Resuscitation. 2024 Jul;200:110214. doi: 10.1016/j.resuscitation.2024.110214. Epub 2024 Apr 10.
Extracorporeal cardiopulmonary resuscitation (ECPR) may improve survival in refractory out-of-hospital cardiac arrest (OHCA) but also expand the donor pool as these patients often become eligible for organ donation. Our aim is to describe the impact of organ donation in OHCA patients treated with ECPR in a high-volume cardiac arrest centre.
Rate of organ donation (primary outcome), organs harvested, a composite of patient survival with favourable neurological outcome or donation of ≥1 solid organ (ECPR benefit), and the potential total number of individuals benefiting from ECPR (survivors with favourable neurological outcome and potential recipients of one solid organ) were analysed among all-rhythms refractory OHCA patients treated with ECPR between January 2013-November 2022 at San Raffaele Hospital in Milan, Italy.
Among 307 adults with refractory OHCA treated with ECPR (95% witnessed, 66% shockable, low-flow 70 [IQR 58-81] minutes), 256 (83%) died during hospital stay, 33% from brain death. Donation of at least one solid organ occurred in 58 (19%) patients, 53 (17%) after determination of brain death and 5 (1.6%) after determination of circulatory death, contributing a total of 167 solid organs (3.0 [IQR 2.5-4.0] organs/donor). Overall, 196 individuals (29 survivors with favourable neurological outcome and 167 potential recipients of 1 solid organ) possibly benefited from ECPR. ECPR benefit composite outcome was achieved in 87 (28%) patients. Solid organ donation decreased from 19% to 16% in patients with low-flow <60 min and to 11% with low-flow <60 min and initial shockable rhythm.
When ECPR fails in patients with refractory OHCA, organ donation after brain or circulatory death can help a significant number of patients awaiting transplantation, enhancing the overall benefit of ECPR. ECPR selection criteria may affect the number of potential organ donors.
体外心肺复苏（ECPR）可能会提高难治性院外心脏骤停（OHCA）患者的生存率，但也会扩大供体池，因为这些患者通常有资格进行器官捐献。我们的目的是描述在高容量心脏骤停中心接受 ECPR 治疗的 OHCA 患者中器官捐献的影响。
在意大利米兰圣拉斐尔医院，我们分析了 2013 年 1 月至 2022 年 11 月期间所有节律性难治性 OHCA 患者接受 ECPR 治疗的器官捐献率（主要结局）、器官采集量、患者生存且神经功能良好或捐献≥1 个实体器官的复合结果（ECPR 获益）以及 ECPR 可能使受益的总人数（神经功能良好的幸存者和潜在的实体器官接受者）。
在 307 例接受 ECPR 治疗的难治性 OHCA 成年患者中（95%为目击者，66%为可电击节律，低血流时间 70[IQR 58-81]分钟），256 例（83%）在住院期间死亡，33%死于脑死亡。至少捐献 1 个实体器官的患者有 58 例（19%），53 例（17%）在脑死亡确定后，5 例（1.6%）在循环死亡确定后，总共捐献了 167 个实体器官（3.0[IQR 2.5-4.0]个/供体）。总体而言，196 名患者（29 名神经功能良好的幸存者和 167 名潜在的 1 个实体器官接受者）可能受益于 ECPR。ECPR 获益复合结果在 87 例（28%）患者中实现。低血流<60 分钟且初始可电击节律的患者中，实体器官捐献率从 19%降至 16%，低血流<60 分钟且初始可电击节律的患者中，实体器官捐献率从 19%降至 11%。
当难治性 OHCA 患者的 ECPR 治疗失败时，脑死亡或循环死亡后的器官捐献可以帮助等待移植的大量患者，从而提高 ECPR 的整体获益。ECPR 选择标准可能会影响潜在器官捐献者的数量。
