Abstract 11974: Impact of Routine ECPR Service on Availability of Donor Organs

Introduction: In refractory cardiac arrest, extracorporeal cardiopulmonary resuscitation (ECPR) may increase the chance of survival. However, in brain death or donation after cardiac death scenario, ECPR may also become an important organ donor source. Hypothesis: We hypothesized that 1/ the implementation of ECPR into the daily routine of a high volume cardiac arrest centre might increase the availability of organ donors, and 2/ ECPR might assure the same long-term function of donated organs as non-ECPR care. Methods: We retrospectively evaluated pre-ECPR (2007-2011) and ECPR (2012-2020) periods in terms of donors recruited from the out-of-hospital and in-hospital cardiac arrest population. We assessed the number of donors referred, the number of organs harvested and their one- and five-year survival. Results: In the pre-ECPR period, 11 donors were referred, of which 7 were accepted. During the ECPR period, the number of donors increased to 80, of which 42 were accepted. The number of donated organs in respective periods were 18 and 119, corresponding to 3,6 vs 13,2 (p =0.033) organs per year harvested. One-year survival of transplanted organs was 94.4% vs 100%, and five-year survival was 94.4% vs 87,5%, in relevant periods. Survival of organs obtained from donors after CPR and ECPR at one year (98.9% vs 100%) and five years (90,2% vs 88.9%) was the same. Graft failure was not the cause of death in any single case. Conclusions: Establishing a high volume cardiac arrest/ECPR centre may lead to a higher number of potential and subsequently accepted organ donors. The length of survival of donated organs is high and comparable between ECPR vs non-ECPR cardiac arrest donors.

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DONORS (Donation Network to Optimise Organ Recovery Study): Study protocol to evaluate the implementation of an evidence-based checklist for brain-dead potential organ donor management in intensive care units, a cluster randomised trial

BMJ Open ◽

10.1136/bmjopen-2018-028570 ◽

2019 ◽

Vol 9 (6) ◽

pp. e028570 ◽

Cited By ~ 2

Author(s):

Glauco Adrieno Westphal ◽

Caroline Cabral Robinson ◽

Alexandre Biasi ◽

Flávia Ribeiro Machado ◽

Regis Goulart Rosa ◽

...

Keyword(s):

Cardiac Arrest ◽

Organ Donor ◽

Evidence Based ◽

Organ Donors ◽

Potential Organ Donor ◽

Cluster Randomised ◽

Recovery Study ◽

Organ Recovery ◽

Brain Dead ◽

Organ Donor Management

IntroductionThere is an increasing demand for multi-organ donors for organ transplantation programmes. This study protocol describes the Donation Network to Optimise Organ Recovery Study, a planned cluster randomised controlled trial that aims to evaluate the effectiveness of the implementation of an evidence-based, goal-directed checklist for brain-dead potential organ donor management in intensive care units (ICUs) in reducing the loss of potential donors due to cardiac arrest.Methods and analysisThe study will include ICUs of at least 60 Brazilian sites with an average of ≥10 annual notifications of valid potential organ donors. Hospitals will be randomly assigned (with a 1:1 allocation ratio) to the intervention group, which will involve the implementation of an evidence-based, goal-directed checklist for potential organ donor maintenance, or the control group, which will maintain the usual care practices of the ICU. Team members from all participating ICUs will receive training on how to conduct family interviews for organ donation. The primary outcome will be loss of potential donors due to cardiac arrest. Secondary outcomes will include the number of actual organ donors and the number of organs recovered per actual donor.Ethics and disseminationThe institutional review board (IRB) of the coordinating centre and of each participating site individually approved the study. We requested a waiver of informed consent for the IRB of each site. Study results will be disseminated to the general medical community through publications in peer-reviewed medical journals.Trial registration numberNCT03179020; Pre-results.

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ECMO in Cardiac Arrest: A Narrative Review of the Literature

Journal of Clinical Medicine ◽

10.3390/jcm10030534 ◽

2021 ◽

Vol 10 (3) ◽

pp. 534

Author(s):

Amandine De Charrière ◽

Benjamin Assouline ◽

Marc Scheen ◽

Nathalie Mentha ◽

Carlo Banfi ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Selection Process ◽

Standard Of Care ◽

High Volume ◽

Narrative Review ◽

Current Evidence ◽

Public Health Issue ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Set Up

Cardiac arrest (CA) is a frequent cause of death and a major public health issue. To date, conventional cardiopulmonary resuscitation (CPR) is the only efficient method of resuscitation available that positively impacts prognosis. Extracorporeal membrane oxygenation (ECMO) is a complex and costly technique that requires technical expertise. It is not considered standard of care in all hospitals and should be applied only in high-volume facilities. ECMO combined with CPR is known as ECPR (extracorporeal cardiopulmonary resuscitation) and permits hemodynamic and respiratory stabilization of patients with CA refractory to conventional CPR. This technique allows the parallel treatment of the underlying etiology of CA while maintaining organ perfusion. However, current evidence does not support the routine use of ECPR in all patients with refractory CA. Therefore, an appropriate selection of patients who may benefit from this procedure is key. Reducing the duration of low blood flow by means of performing high-quality CPR and promoting access to ECPR, may improve the survival rate of the patients presenting with refractory CA. Indeed, patients who benefit from ECPR seem to carry better neurological outcomes. The aim of this present narrative review is to present the most recent literature available on ECPR and to clarify its potential therapeutic role, as well as to provide an in-depth explanation of equipment and its set up, the patient selection process, and the patient management post-ECPR.

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A retrospective analysis of inpatient cardiac arrests over one year at a tertiary heart attack and cardiothoracic centre identifying potential candidates for an inpatient extracorporeal cardiopulmonary resuscitation service

Journal of the Intensive Care Society ◽

10.1177/1751143719848660 ◽

2019 ◽

Vol 21 (2) ◽

pp. 105-110

Author(s):

Suzanne Harrogate ◽

Benjamin Stretch ◽

Rosie Seatter ◽

Simon Finney ◽

Ben Singer

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Case Series ◽

Working Hours ◽

Inclusion Criteria ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Improved Outcomes ◽

Number Of Patients ◽

Cardiac Centre ◽

One Year

Introduction Extracorporeal cardiopulmonary resuscitation (ECPR) is an internationally recognised treatment for refractory cardiac arrest, with evidence of improved outcomes in selected patient groups from cohort studies and case series. In order to establish the clinical need for an in-hospital extracorporeal cardiopulmonary resuscitation service at a tertiary cardiac centre, we analysed the inpatient cardiac arrest database for the previous 12 months. Methods Evidence-based inclusion criteria were used to retrospectively identify the number of patients potentially eligible for extracorporeal cardiopulmonary resuscitation over a 12-month period. Results A total of 261 inpatient cardiac arrests were analysed with 21 potential extracorporeal cardiopulmonary resuscitation candidates meeting the inclusion criteria (1.75 patients per month, or 8% of inpatient cardiac arrests (21/261)). The majority (71%) of these cardiac arrests occurred outside of normal working hours. Survival-to-discharge within this sub-group with conventional cardiopulmonary resuscitation was 19% (4/21). Conclusion Sufficient numbers of refractory inpatient cardiac arrests occur to justify an extracorporeal cardiopulmonary resuscitation service, but a 24-h on-site extracorporeal membrane oxygenation team presents a significant financial and logistical challenge.

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Ethical issues of organ donation after cardiac death

Russian Journal of Transplantology and Artificial Organs ◽

10.15825/1995-1191-2018-3-116-125 ◽

2018 ◽

Vol 20 (3) ◽

pp. 116-125 ◽

Cited By ~ 1

Author(s):

O. N. Reznik ◽

A. E. Skvortcov ◽

O. V. Popova

Keyword(s):

Cardiac Arrest ◽

Ethical Issues ◽

Organ Procurement ◽

Organ Transplant ◽

Point Of View ◽

Donation After Cardiac Death ◽

Organ Donors ◽

Artificial Blood ◽

Transplant Program ◽

Opposite Position

There is renewal of interests to the organs that could be obtained from asystolic donors. Our goal was to identify ethical issues raised by attempts of classification and terms such kind of organ donors depended on time and place of cardiac arrest. Based only on the reasoning of medical experts group these principles going to be routine State policy. That followed by erased roles of physicians and misleading the meaning or organ transplant program. From our point of view there should be clear opposite position between death and life in order to initiate organ procurement activity. That is possible only in case of artificial blood supply for preserving transplant-to-be-organs after relevant time between cardiac arrest and start of such kind of perfusion procedure.

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Faculty Opinions recommendation of Extracorporeal Cardiopulmonary Resuscitation: One-Year Survival and Neurobehavioral Outcome Among Infants and Children With In-Hospital Cardiac Arrest.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.734432298.793555132 ◽

2019 ◽

Author(s):

Graeme MacLaren

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Infants And Children ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

One Year ◽

Hospital Cardiac Arrest ◽

Neurobehavioral Outcome

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Assessing unrealised potential for organ donation after out-of-hospital cardiac arrest

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-021-00924-z ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Andrew Fu Wah Ho ◽

Timothy Xin Zhong Tan ◽

Ejaz Latiff ◽

Nur Shahidah ◽

Yih Yng Ng ◽

...

Keyword(s):

Cardiac Arrest ◽

Organ Donation ◽

Organ Donor ◽

Case Scenario ◽

Eligibility Criteria ◽

Donor Pool ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Worst Case ◽

Hospital Cardiac Arrest

Abstract Background Organ donation after brain death is the standard practice in many countries. Rates are low globally. This study explores the potential national number of candidates for uncontrolled donations after cardiac death (uDCD) amongst out-of-hospital cardiac arrest (OHCA) patients and the influence of extracorporeal cardiopulmonary resuscitation (ECPR) on the candidacy of these potential organ donors using Singapore as a case study. Methods Using Singapore data from the Pan-Asian Resuscitation Outcomes Study, we identified all non-traumatic OHCA cases from 2010 to 2016. Four established criteria for identifying uDCD candidates (Madrid, San Carlos Madrid, Maastricht and Paris) were retrospectively applied onto the population. Within these four groups, a condensed ECPR eligibility criteria was employed and thereafter, an estimated ECPR survival rate was applied, extrapolating for possible neurologically intact survivors had ECPR been administered. Results 12,546 OHCA cases (64.8% male, mean age 65.2 years old) qualified for analysis. The estimated number of OHCA patients who were eligible for uDCD ranged from 4.3 to 19.6%. The final projected percentage of potential uDCD donors readjusted for ECPR survivors was 4.2% (Paris criteria worst-case scenario, n = 532) to 19.4% of all OHCA cases (Maastricht criteria best-case scenario, n = 2428), for an estimated 14.3 to 65.4 uDCD donors per million population per year (pmp/year). Conclusions In Singapore case study, we demonstrated the potential numbers of candidates for uDCD among resuscitated OHCA cases. This sizeable pool of potential donors demonstrates the potential for an uDCD program to expand the organ donor pool. A small proportion of these patients might however survive had they been administered ECPR. Further research into the factors influencing local organ and patient outcomes following uDCD and ECPR is indicated.

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Management of out-of hospital cardiac arrest patients with extracorporeal cardiopulmonary resuscitation in 2021

Expert Review of Medical Devices ◽

10.1080/17434440.2021.1886076 ◽

2021 ◽

pp. 1-10

Author(s):

Christopher Gaisendrees ◽

Matias Vollmer ◽

Sebastian G Walter ◽

Ilija Djordjevic ◽

Kaveh Eghbalzadeh ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Hospital Cardiac Arrest

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Contacts to the healthcare system prior to out-of-hospital cardiac arrests

European Heart Journal ◽

10.1093/ehjci/ehaa946.0766 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

N Zylyftari ◽

S.G Moller ◽

M Wissenberg ◽

F Folke ◽

C.A Barcella ◽

...

Keyword(s):

Cardiac Arrest ◽

General Population ◽

Healthcare System ◽

Early Identification ◽

Sudden Cardiac Arrest ◽

Funding Source ◽

Horizon 2020 ◽

One Year ◽

Public Grant ◽

Hospital Cardiac Arrest

Abstract Background Patients who suffer a sudden out-of-hospital cardiac arrest (OHCA) may be preceded by warning symptoms and healthcare system contact. Though, is currently difficult early identification of sudden cardiac arrest patients. Purpose We aimed to examine contacts with the healthcare system up to two weeks and one year before OHCA. Methods OHCA patients were identified from the Danish Cardiac Arrest Registry (2001–2014). The pattern of healthcare contacts (with either general practitioner (GP) or hospital) within the year prior to OHCA of OHCA patients was compared with that of 9 sex- and age-matched controls from the background general population. Additionally, we evaluated characteristics of OHCA patients according to the type of healthcare contact (GP/hospital/both/no-contact) and the including characteristics of contacts, within two weeks prior their OHCA event. Results Out of 28,955 OHCA patients (median age of 72 (62–81) years and with 67% male) of presumed cardiac cause, 16,735 (57.8%) contacted the healthcare system (GP and hospital) within two weeks prior to OHCA. From one year before OHCA, the weekly percentages of contacts to GP were relatively constant (26%) until within 2 weeks prior to OHCA where they markedly increased (54%). In comparison, 14% of the general population contacted the GP during the same period (Figure). The weekly percentages of contacts with hospitals gradually increased in OHCA patients from 3.5% to 6.5% within 6 months, peaking at the second week (6.8%), prior to OHCA. In comparison, only 2% of the general population had a hospital contact in that period (Figure). Within 2 weeks of OHCA, patients contacted GP mainly by telephone (71.6%). Hospital diagnoses were heterogenous, where ischemic heart disease (8%) and heart failure (4.5%) were the most frequent. Conclusions There is an increase in healthcare contacts prior to “sudden” OHCA and overall, 54% of OHCA-patients had contacted GP within 2 weeks before the event. This could have implications for developing future strategies for early identification of patients prior to their cardiac arrest. Figure 1. The weekly percentages of contacts to GP (red) and hospital (blue) within one year before OHCA comparing the OHCA cases to the age- and sex-matched control population (N cases = 28,955; N controls = 260,595). Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): European Union's Horizon 2020

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Does Targeted Temperature Management Improve Neurological Outcome in Extracorporeal Cardiopulmonary Resuscitation (ECPR)?

Journal of Intensive Care Medicine ◽

10.1177/08850666211018982 ◽

2021 ◽

pp. 088506662110189

Author(s):

Merry Huang ◽

Aaron Shoskes ◽

Migdady Ibrahim ◽

Moein Amin ◽

Leen Hasan ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Neurological Outcome ◽

Targeted Temperature Management ◽

Temperature Management ◽

Survival Outcomes ◽

Pool Data ◽

Good Neurological Outcome ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Over Time

Purpose: Targeted temperature management (TTM) is a standard of care in patients after cardiac arrest for neuroprotection. Currently, the effectiveness and efficacy of TTM after extracorporeal cardiopulmonary resuscitation (ECPR) is unknown. We aimed to compare neurological and survival outcomes between TTM vs non-TTM in patients undergoing ECPR for refractory cardiac arrest. Methods: We searched PubMed and 5 other databases for randomized controlled trials and observational studies reporting neurological outcomes or survival in adult patients undergoing ECPR with or without TTM. Good neurological outcome was defined as cerebral performance category <3. Two independent reviewers extracted the data. Random-effects meta-analyses were used to pool data. Results: We included 35 studies (n = 2,643) with the median age of 56 years (interquartile range [IQR]: 52-59). The median time from collapse to ECMO cannulation was 58 minutes (IQR: 49-82) and the median ECMO duration was 3 days (IQR: 2.0-4.1). Of 2,643, 1,329 (50.3%) patients received TTM and 1,314 (49.7%) did not. There was no difference in the frequency of good neurological outcome at any time between TTM (29%, 95% confidence interval [CI]: 23%-36%) vs. without TTM (19%, 95% CI: 9%-31%) in patients with ECPR ( P = 0.09). Similarly, there was no difference in overall survival between patients with TTM (30%, 95% CI: 22%-39%) vs. without TTM (24%, 95% CI: 14%-34%) ( P = 0.31). A cumulative meta-analysis by publication year showed improved neurological and survival outcomes over time. Conclusions: Among ECPR patients, survival and neurological outcome were not different between those with TTM vs. without TTM. Our study suggests that neurological and survival outcome are improving over time as ECPR therapy is more widely used. Our results were limited by the heterogeneity of included studies and further research with granular temperature data is necessary to assess the benefit and risk of TTM in ECPR population.

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