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01-01-2008 | Original

An underrecognized source of organ donors: patients with brain death after successfully resuscitated cardiac arrest

Authors: Christophe Adrie, Hakim Haouache, Mohamed Saleh, Nathalie Memain, Ivan Laurent, Marie Thuong, Loic Darques, Patrice Guerrini, Mehran Monchi

Published in: Intensive Care Medicine | Issue 1/2008

Abstract

Objective

To identify predictors of brain death after successful resuscitation of out-of-hospital cardiac arrest (OHCA), with the goal of improving the detection of brain death, and to evaluate outcomes of solid organs harvested from these patients.

Design and setting

Prospective observational cohort study in a medical and surgical unit of a nonuniversity hospital.

Patients

Patients with successfully resuscitated OHCA were prospectively included in a database over a 7-year period. We looked for early predictors of brain death and compared outcomes of organ transplants from these patients to those from patients with brain death due to head injury or stroke.

Results

Over the 7-year period 246 patients were included. No early predictors of brain death were found. Of the 40 patients (16%) who met criteria for brain death, after a median ICU stay of 2.5 days (IQR 2.0–4.2), 19 donated 52 solid organs (29 kidneys, 14 livers, 7 hearts, and 2 lungs). Outcomes of kidneys and livers did not differ between donors with and without resuscitated cardiac arrest.

Conclusions

Brain death may occur in about one-sixth of patients after successfully resuscitated OHCA, creating opportunities for organ donation.

Eisenberg MS, Mengert TJ (2001) Cardiac resuscitation. N Engl J Med 344:1304–1313PubMedCrossRef

Callans DJ (2004) Out-of-hospital cardiac arrest-the solution is shocking. N Engl J Med 351:632–634PubMedCrossRef

Bunch TJ, White RD, Gersh BJ, Meverden RA, Hodge DO, Ballman KV, Hammill SC, Shen WK, Packer DL (2003) Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation. N Engl J Med 348:2626–2633PubMedCrossRef

Negovsky VA (1972) The second step in resuscitation-the treatment of the ‘post- resuscitation disease’. Resuscitation 1:1–7PubMedCrossRef

Adrie C, Adib-Conquy M, Laurent I, Monchi M, Vinsonneau C, Fitting C, Fraisse F, Dinh-Xuan A, Carli P, Spaulding C, Dhainaut J-F, Cavaillon J-M (2002) Successful cardiopulmonary resuscitation after cardiac arrest as a “sepsis like” syndrome. Circulation 106:562–568PubMedCrossRef

Adrie C, Monchi M, Laurent I, Um S, Yan SB, Thuong M, Cariou A, Charpentier J, Dhainaut JF (2005) Coagulopathy after successful cardiopulmonary resuscitation following cardiac arrest: implication of the protein C anticoagulant pathway. J Am Coll Cardiol 46:21–28PubMedCrossRef

Hekimian G, Baugnon T, Thuong M, Monchi M, Dabbane H, Jaby D, Rhaoui A, Laurent I, Moret G, Fraisse F, Adrie C (2004) Cortisol levels and adrenal reserve after successful cardiac arrest resuscitation. Shock 22:116–119PubMedCrossRef

Mercatello A, Roy P, Ng-Sing K, Choux C, Baude C, Garnier JL, Colpart JJ, Finaz J, Petit P, Moskovtchenko JF et al (1988) Organ transplants from out-of-hospital cardiac arrest patients. Transplant Proc 20:749–750PubMed

Delaunay L, Denis V, Darmon PL, Catoire P, Bonnet F (1996) Initial cardiac arrest is a risk factor for failure of organ procurement in brain-dead patients. Transplant Proc 28:2894PubMed

10.

Wilson DJ, Fisher A, Das K, Goerlitz F, Holland BK, De La Torre AN, Merchant A, Seguel J, Samanta AK, Koneru B (2003) Donors with cardiac arrest: improved organ recovery but no preconditioning benefit in liver allografts. Transplantation 75:1683–1687PubMedCrossRef

11.

Booth CM, Boone RH, Tomlinson G, Detsky AS (2004) Is this patient dead, vegetative, or severely neurologically impaired? Assessing outcome for comatose survivors of cardiac arrest. JAMA 291:870–879PubMedCrossRef

12.

Wijdicks EF, Hijdra A, Young GB, Bassetti CL, Wiebe S (2006) Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 67:203–210PubMedCrossRef

13.

Zandbergen EG, de Haan RJ, Stoutenbeek CP, Koelman JH, Hijdra A (1998) Systematic review of early prediction of poor outcome in anoxic-ischaemic coma. Lancet 352:1808–1812PubMedCrossRef

14.

Zandbergen EG, Hijdra A, Koelman JH, Hart AA, Vos PE, Verbeek MM, de Haan RJ (2006) Prediction of poor outcome within the first 3 days of postanoxic coma. Neurology 66:62–68PubMedCrossRef

15.

Laver S, Farrow C, Turner D, Nolan J (2004) Mode of death after admission to an intensive care unit following cardiac arrest. Intensive Care Med 30:2126–2128PubMedCrossRef

16.

Adrie C, Cariou A, Mourvillier B, Laurent I, Dabbane H, Hantala F, Rhaoui A, Thuong M, Monchi M (2006) Predicting survival with good neurological recovery at hospital admission after successful resuscitation of out-of-hospital cardiac arrest: the OHCA score. Eur Heart J 27:2840–2845PubMedCrossRef

17.

Cummins RO, Chamberlain DA, Abramson NS, Allen M, Baskett PJ, Becker L, Bossaert L, Delooz HH, Dick WF, Eisenberg MS et al (1991) Recommended guidelines for uniform reporting of data from out-of- hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Circulation 84:960–975PubMed

18.

Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963PubMedCrossRef

19.

Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710PubMedCrossRef

20.

Gridelli B, Remuzzi G (2000) Strategies for making more organs available for transplantation. N Engl J Med 343:404–410PubMedCrossRef

21.

American Heart Association (2005) Guidelines for cardiopulmonary resuscitation and emergency cardiovascular medicine. Circulation 112:S1–S121CrossRef

22.

International Liaison Committee on Resuscitation (2005). Part 4: advanced life support. Resuscitation 67:213–247CrossRef

23.

Nolan JP, Deakin CD, Soar J, Bottiger BW, Smith G (2005) European Resuscitation Council guidelines for resuscitation 2005. Section 4. Adult advanced life support. Resuscitation [Suppl] 67(1):S39–S86CrossRef

24.

Gueugniaud PY, Mols P, Goldstein P, Pham E, Dubien PY, Deweerdt C, Vergnion M, Petit P, Carli P (1998) A comparison of repeated high doses and repeated standard doses of epinephrine for cardiac arrest outside the hospital. European Epinephrine Study Group. N Engl J Med 339:1595–1601PubMedCrossRef

25.

Laurent I, Monchi M, Chiche JD, Joly LM, Spaulding C, Bourgeois B, Cariou A, Rozenberg A, Carli P, Weber S, Dhainaut JF (2002) Reversible mycocardial dysfunction in survivors of out-of-hospital cardiac arrest. J Am Coll Cardiol 40:2110–2116PubMedCrossRef

26.

Wood KE, Becker BN, McCartney JG, D'Alessandro AM, Coursin DB (2004) Care of the potential organ donor. N Engl J Med 351:2730–2739PubMedCrossRef

27.

Ali AA, Lim E, Thanikachalam M, Sudarshan C, White P, Parameshwar J, Dhital K, Large SR (2007) Cardiac arrest in the organ donor does not negatively influence recipient survival after heart transplantation. Eur J Cardiothorac Surg 31:929–933PubMedCrossRef

Title: An underrecognized source of organ donors: patients with brain death after successfully resuscitated cardiac arrest
Authors: Christophe Adrie
Hakim Haouache
Mohamed Saleh
Nathalie Memain
Ivan Laurent
Marie Thuong
Loic Darques
Patrice Guerrini
Mehran Monchi
Publication date: 01-01-2008
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 1/2008
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-007-0885-7

At a glance: The STEP trials

Springer Medicine

An underrecognized source of organ donors: patients with brain death after successfully resuscitated cardiac arrest

Abstract

Objective

Design and setting

Patients

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Design and setting

Patients

Results

Conclusions

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