University of Minnesota Medical School, Department of Medicine, Division of Cardiology, Center for Resuscitation Medicine, MN, USA.
University of California, San Francisco, Department of Medicine, CA, USA.
Resuscitation. 2024 Oct;203:110391. doi: 10.1016/j.resuscitation.2024.110391. Epub 2024 Sep 5.
This study explores the evolution of organ donation from patients treated with extracorporeal-cardiopulmonary-resuscitation (ECPR) for refractory out-of-hospital-cardiac-arrest (OHCA) and evaluates the public health benefits of a mature ECPR program.
This retrospective, single-center study included OHCA patients (2016-2023) who had mostly initial shockable rhythms and were treated with ECPR. Organ donation rates from non-survivors through these years were analyzed. The public health benefit of ECPR was determined by the ratio of the sum of survivors with Cerebral Performance Category 1-2 and non-survivors who donated at least 1 solid organ, to the total ECPR patients. Temporal trends were analyzed yearly using linear regression.
Out of 419 ECPR patients presenting with refractory OHCA over the study period, 116 survived neurologically intact (27.7%). Among non-survivors (n = 303), families of 41 (13.5%) consented to organ donation (median age 51 years, 75.6% male) and organs from 38 patients were harvested, leading to 74 organ transplants to 73 recipients. The transplanted organs included 43 kidneys (58.1%), 27 livers (36.5%), 3 lungs (4%), and 1 heart (1.4%), averaging 2.4 ± 0.9 accepted organs/donor. The number of organ donors and successful transplants correlated positively with the years since the ECPR program's initiation (p = 0.009, p = 0.01). Overall, 189 patients (116 survivors, 73 organ recipients) benefited from ECPR, achieving organ-failure-free survival. The cumulative public health benefit of ECPR, considering the 116 survivors and 38 donors was 36.8%.
The public health benefits of an established ECPR program extend beyond individual ECPR patient survival, forming a new, previously under-recognized source of transplant donors.
本研究旨在探讨体外心肺复苏（ECPR）治疗难治性院外心脏骤停（OHCA）患者的器官捐献演变，并评估成熟 ECPR 项目的公共卫生效益。
这是一项回顾性、单中心研究，纳入了 2016 年至 2023 年期间接受 ECPR 治疗、初始多为可电击节律的 OHCA 患者。分析了这些年非幸存者的器官捐献率。ECPR 的公共卫生效益通过幸存者中具有神经功能 1-2 级和至少捐献 1 个实体器官的非幸存者与接受 ECPR 的患者总数的比例来确定。使用线性回归每年分析时间趋势。
在研究期间，419 例接受 ECPR 治疗的难治性 OHCA 患者中，116 例存活且神经功能完整（27.7%）。在非幸存者（n=303）中，41 例（13.5%）家属同意捐献器官（中位年龄 51 岁，75.6%为男性），38 例患者的器官被采集，共进行了 74 例器官移植，移植给 73 例受者。移植的器官包括 43 个肾脏（58.1%）、27 个肝脏（36.5%）、3 个肺（4%）和 1 个心脏（1.4%），平均每个供者接受 2.4±0.9 个器官。器官捐献者和成功移植的数量与 ECPR 项目启动以来的时间呈正相关（p=0.009，p=0.01）。总体而言，189 例患者（116 例幸存者，73 例器官受者）受益于 ECPR，实现了无器官衰竭存活。考虑到 116 例幸存者和 38 例捐献者，ECPR 的累计公共卫生效益为 36.8%。
成熟 ECPR 项目的公共卫生效益不仅限于单个 ECPR 患者的存活，还形成了一个新的、以前未被认识到的移植供者来源。
