Organ donation in cardiac arrest patients treated with extracorporeal CPR: A single centre observational study

Aim of the study In a consecutive cohort of cardiac arrest (CA) treated with extracorporeal cardiopulmonary resuscitation (eCPR), we describe the incidence of brain death (BD), the eligibility for organ donation and the short-term follow-up of the transplanted organs. Methods All refractory in- and out-of-hospital CA admitted to our Cardiac Intensive Care Unit between January 2011 and September 2016 treated with eCPR were enrolled in the study. Results 112 CA patients received eCPR. 82 (73.2%) died in hospital, 25 BD (22.3%) and 57 for other causes (50.9%). At the time of first neurological evaluation after rewarming, variables related to evolution to BD were a lower GCS (3 [3-3] vs. 8 [3–11], p< 0.001), a higher level of neuron specific enolase (269.3 ± 49.4 vs. 55.2 ± 37.2 ng/ml, p < 0.001), a higher presence of EEG indices of poor outcome (84% vs. 15%, p < 0.001), absence of brainstem reflexes (p < 0.001), absence of bilateral N20 SSEPS waves (66.7% vs. 3.7%, p < 0.001). None of BD patients present a normal CT scan (at 2.5 ± 2 days), with 85% prevalence of diffuse hypoxic injury and a mean grey/white matter ratio of 1.1 ± 0.1. Rate of donation in BD patients was 56%, with 39 donated organs: 23 kidneys, 12 livers, and 4 lungs. 89.74% of the transplanted organs reached an early good functional recovery. Conclusion In refractory CA patients treated with eCPR, the prevalence of BD is high. This population has a high potential for considering organ donation. Donated organs have a good outcome.