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Outcomes following out-of-hospital cardiac arrest: What is the potential for donation after circulatory death?

ABSTRACT: 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 The remaining 36 patients had treatment withdrawn in the intensive care unit.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.

SUBMITTER: Tordoff CC

PROVIDER: S-EPMC5606394 | biostudies-literature | 2016 May

REPOSITORIES: biostudies-literature

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Outcomes following out-of-hospital cardiac arrest: What is the potential for donation after circulatory death?

Tordoff Claire C CC Bodenham Andrew R AR

Journal of the Intensive Care Society 20151125 2

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 d ...[more]

PMID: 28979472

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Project description:ImportanceOut-of-hospital cardiac arrest (OHCA) health care provision may be a good indicator of the recovery of the health care system involved in OHCA care following the COVID-19 pandemic. There is a lack of data regarding outcomes capable of verifying this recovery.ObjectiveTo determine whether return to spontaneous circulation, overall survival, and survival with good neurological outcome increased in patients with OHCA since the COVID-19 pandemic was brought under control in 2022 compared with prepandemic and pandemic levels.Design, setting, and participantsThis observational cohort study was conducted to examine health care response and survival with good neurological outcome at hospital discharge in patients treated following OHCA. A 3-month period, including the first wave of the pandemic (February 1 to April 30, 2020), was compared with 2 periods before (April 1, 2017, to March 31, 2018) and after (January 1 to December 31, 2022) the pandemic. Data analysis was performed in July 2023. Emergency medical services (EMS) serving a population of more than 28 million inhabitants across 10 Spanish regions participated. Patients with OHCA were included if participating EMS initiated resuscitation or continued resuscitation initiated by a first responder.ExposureThe pandemic was considered to be under control following the official declaration that infection with SARS-CoV-2 was to be considered another acute respiratory infection.Main outcome and measuresThe main outcomes were return of spontaneous circulation, overall survival, and survival at hospital discharge with good neurological outcome, expressed as unimpaired or minimally impaired cerebral performance.ResultsA total of 14 732 patients (mean [SD] age, 64.2 [17.2] years; 10 451 [71.2%] male) were included, with 6372 OHCAs occurring during the prepandemic period, 1409 OHCAs during the pandemic period, and 6951 OHCAs during the postpandemic period. There was a higher incidence of OHCAs with a resuscitation attempt in the postpandemic period compared with the pandemic period (rate ratio, 4.93; 95% CI, 4.66-5.22; P < .001), with lower incidence of futile resuscitation for OHCAs (2.1 per 100 000 person-years vs 1.3 per 100 000 person-years; rate ratio, 0.81; 95% CI, 0.71-0.92; P < .001). Recovery of spontaneous circulation at hospital admission increased from 20.5% in the pandemic period to 30.5% in the postpandemic period (relative risk [RR], 1.08; 95% CI, 1.06-1.10; P < .001). In the same way, overall survival at discharge increased from 7.6% to 11.2% (RR, 1.45; 95% CI, 1.21-1.75; P < .001), with 6.6% of patients being discharged with good neurological status (Cerebral Performance Category Scale categories 1-2) in the pandemic period compared with 9.6% of patients in the postpandemic period (RR, 1.07; 95% CI, 1.04-1.10; P < .001).Conclusions and relevanceIn this cohort study, survival with good neurological outcome at hospital discharge following OHCA increased significantly after the COVID-19 pandemic.

Project description:BackgroundMechanical circulatory support (MCS) with either extracorporeal membrane oxygenation or Impella has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). The objective of this study was to describe the gradual implementation, survival and adherence to the national consensus with respect to use of MCS for OHCA in Denmark, and to identify factors associated with outcome.MethodsThis retrospective, observational cohort study included patients receiving MCS for OHCA at all tertiary cardiac arrest centers (n = 4) in Denmark between July 2011 and December 2020. Logistic regression and Kaplan-Meier survival analysis were used to determine association with outcome. Outcome was presented as survival to hospital discharge with good neurological outcome, 30-day survival and predictors of 30-day mortality.ResultsA total of 259 patients were included in the study. Thirty-day survival was 26%. Sixty-five (25%) survived to hospital discharge and a good neurological outcome (Glasgow-Pittsburgh Cerebral Performance Categories 1-2) was observed in 94% of these patients. Strict adherence to the national consensus showed a 30-day survival rate of 30% compared with 22% in patients violating one or more criteria. Adding criteria to the national consensus such as signs of life during cardiopulmonary resuscitation (CPR), pre-hospital low-flow < 100 min, pH > 6.8 and lactate < 15 mmol/L increased the survival rate to 48%, but would exclude 58% of the survivors from the current cohort. Logistic regression identified asystole (RR 1.36, 95% CI 1.18-1.57), pulseless electrical activity (RR 1.20, 95% CI 1.03-1.41), initial pH < 6.8 (RR 1.28, 95% CI 1.12-1.46) and lactate levels > 15 mmol/L (RR 1.16, 95% CI 1.16-1.53) as factors associated with increased risk of 30-day mortality. Patients presenting signs of life during CPR had reduced risk of 30-day mortality (RR 0.63, 95% CI 0.52-0.76).ConclusionsA high survival rate with a good neurological outcome was observed in this Danish population of patients treated with MCS for OHCA. Stringent patient selection for MCS may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors.

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Outcomes following out-of-hospital cardiac arrest: What is the potential for donation after circulatory death?

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Outcomes following out-of-hospital cardiac arrest: What is the potential for donation after circulatory death?

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