Organ donation after brain death in refractory cardiac arrest treated with extracorporeal CPR

Introduction: Cardiac arrest (CA) is a catastrophic event with a high rate of mortality, often resulting in devastating brain injury that might evolve to brain death (BD)[1]. Organ donation from BD after CA patients with ECMO support is still a poorly explored field[2]. Methods: We retrospectively enrolled all patients admitted to our hospital between January 2011 and September 2016 after refractory CA treated with eCPR. Results: In the study period 112/215 CA patients received eCPR (52.09%). 30 eCPR-subjects (26.78%) survived at 6 months (85.71% with good cerebral performance, CPC 1-2). 82 died in ICU (25 BD, 22.32% and 57 for other causes, 50.89%)[Fig.1]. Deads vs. alives differed in age (p=0.02), comorbidities (p=0.001), CA (intra or extrahospital p=0.03), low flow time (p<0.0001), mean arterial pressure (p=0.004), glycemia (p=0.04) anemia (p=0.02), renal function (creatinine p<0.0001, urea p=0.0005), and early neurological evaluation (CT scan p<0.001, EEG recording p<0.001, brainstem reflexes p<0.001, presence of somatosensory potentials p=0.03 and GCS p<0.0001). BD and dead from other causes patients differed in early neurological evaluation (CT scan p<0.0001, EEG p=0.004, brainstem reflexes p=0.02), thrombocytopenia (p=0.008), coagulation derangement (p=0.01), inotropic support (p=0.03). Tab1 shows characteristics of eligible patients at the time of donation. Rate of donation in BD patients was 56% (refusal based on organ biopsy or evaluation in the operation room) with 39 donated organs (23 kidneys, 12 livers, 4 lungs, 89.74% with good functional recovery). Conclusions: eCPR patients might become BD and be considered potential resource for organ donation with a similar success rate as organs retrieved from patients deceased from other causes