Organ donation after out-of-hospital cardiac arrest: a population-based study of data from the Paris Sudden Death Expertise Center,Annals of Intensive Care

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Organ donation after out-of-hospital cardiac arrest: a population-based study of data from the Paris Sudden Death Expertise Center
Annals of Intensive Care ( IF 5.7 ) Pub Date : 2022-06-06 , DOI: 10.1186/s13613-022-01023-7
M Renaudier _{1,

2} , Y Binois _{1,

2} , F Dumas _{1,

2,

3,

4} , L Lamhaut _{1,

2,

4,

5} , F Beganton _{1,

2} , D Jost _{1,

2,

6} , J Charpentier ₇ , O Lesieur _{4,

8} , E Marijon _{1,

2,

4,

9} , X Jouven _{1,

2,

4,

9} , A Cariou _{1,

2,

4,

7} , W Bougouin _{1,

2,

10} ,

Affiliation

Background

Organ shortage is a major public health issue, and patients who die after out-of-hospital cardiac arrest (OHCA) could be a valuable source of organs. Here, our objective was to identify factors associated with organ donation after brain death complicating OHCA, in unselected patients entered into a comprehensive real-life registry covering a well-defined geographic area.

Methods

We prospectively analyzed consecutive adults with OHCA who were successfully resuscitated, but died in intensive care units in the Paris region in 2011–2018. The primary outcome was organ donation after brain death. Independent risk factors were identified using logistic regression analysis. One-year graft survival was assessed using Cox and log-rank tests.

Results

Of the 3061 included patients, 136 (4.4%) became organ donors after brain death, i.e., 28% of the patients with brain death. An interaction between admission pH and post-resuscitation shock was identified. By multivariate analysis, in patients with post-resuscitation shock, factors associated with organ donation were neurological cause of OHCA (odds ratio [OR], 14.5 [7.6–27.4], P < 0.001), higher pH (OR/0.1 increase, 1.3 [1.1–1.6], P < 0.001); older age was negatively associated with donation (OR/10-year increase, 0.7 [0.6–0.8], P < 0.001). In patients without post-resuscitation shock, the factor associated with donation was neurological cause of OHCA (OR, 6.9 [3.0–15.9], P < 0.001); higher pH (OR/0.1 increase, 0.8 [0.7–1.0], P = 0.04) and OHCA at home (OR, 0.4 [0.2–0.7], P = 0.006) were negatively associated with organ donation. One-year graft survival did not differ according to Utstein characteristics of the donor.

Conclusions

4% of patients who died in ICU after OHCA led to organ donation. Patients with OHCA constitute a valuable source of donated organs, and special attention should be paid to young patients with OHCA of neurological cause.

中文翻译：

院外心脏骤停后器官捐献：基于人群的巴黎猝死专家中心数据研究

背景

器官短缺是一个重大的公共卫生问题，在院外心脏骤停 (OHCA) 后死亡的患者可能是宝贵的器官来源。在这里，我们的目标是确定与脑死亡并发 OHCA 后器官捐献相关的因素，在未经选择的患者中，进入涵盖明确地理区域的综合现实生活登记处。

方法

我们前瞻性地分析了 2011-2018 年巴黎地区连续成功复苏但死于重症监护病房的 OHCA 成人。主要结果是脑死亡后的器官捐献。使用逻辑回归分析确定独立危险因素。使用 Cox 和对数秩检验评估一年移植物存活率。

结果

在纳入的3061例患者中，136例（4.4%）脑死亡后成为器官捐献者，占脑死亡患者的28%。确定了入院 pH 值和复苏后休克之间的相互作用。通过多变量分析，在复苏后休克患者中，与器官捐献相关的因素是 OHCA 的神经系统原因（优势比 [OR]，14.5 [7.6-27.4]，P < 0.001），较高的 pH 值（OR/0.1 增加，1.3 [1.1-1.6]，P < 0.001）；年龄较大与捐赠呈负相关（OR/10 年增加，0.7 [0.6-0.8]，P < 0.001）。在没有复苏后休克的患者中，与捐献相关的因素是 OHCA 的神经系统原因（OR，6.9 [3.0–15.9]，P < 0.001）；更高的 pH 值（OR/0.1 增加，0.8 [0.7–1.0]，P = 0.04）和在家中的 OHCA（OR，0.4 [0.2-0.7]，P = 0.006）与器官捐赠呈负相关。根据供体的 Utstein 特征，一年的移植物存活率没有差异。