Organ donation after out-of-hospital cardiac arrest: a population-based study of data from the Paris Sudden Death Expertise Center.
Brain death
Epidemiology
Organ donation
Out-of-hospital cardiac arrest
Journal
Annals of intensive care
ISSN: 2110-5820
Titre abrégé: Ann Intensive Care
Pays: Germany
ID NLM: 101562873
Informations de publication
Date de publication:
06 Jun 2022
06 Jun 2022
Historique:
received:
21
02
2022
accepted:
11
05
2022
entrez:
6
6
2022
pubmed:
7
6
2022
medline:
7
6
2022
Statut:
epublish
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
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
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.
Identifiants
pubmed: 35666323
doi: 10.1186/s13613-022-01023-7
pii: 10.1186/s13613-022-01023-7
pmc: PMC9170852
doi:
Types de publication
Journal Article
Langues
eng
Pagination
48Investigateurs
F Adnet
(F)
J M Agostinucci
(JM)
N Aissaoui-Balanant
(N)
V Algalarrondo
(V)
F Alla
(F)
C Alonso
(C)
W Amara
(W)
D Annane
(D)
C Antoine
(C)
P Aubry
(P)
E Azoulay
(E)
F Beganton
(F)
C Billon
(C)
W Bougouin
(W)
J Boutet
(J)
C Bruel
(C)
P Bruneval
(P)
A Cariou
(A)
P Carli
(P)
E Casalino
(E)
C Cerf
(C)
A Chaib
(A)
B Cholley
(B)
Y Cohen
(Y)
A Combes
(A)
J M Coulaud
(JM)
M Crahes
(M)
D Da Silva
(D)
V Das
(V)
A Demoule
(A)
I Denjoy
(I)
N Deye
(N)
J L Diehl
(JL)
S Dinanian
(S)
L Domanski
(L)
D Dreyfuss
(D)
D Duboc
(D)
J L Dubois-Rande
(JL)
F Dumas
(F)
J Duranteau
(J)
J P Empana
(JP)
F Extramiana
(F)
J Y Fagon
(JY)
M Fartoukh
(M)
F Fieux
(F)
M Gabbas
(M)
E Gandjbakhch
(E)
G Geri
(G)
B Guidet
(B)
F Halimi
(F)
P Henry
(P)
F Hidden Lucet
(F)
P Jabre
(P)
L Joseph
(L)
D Jost
(D)
X Jouven
(X)
N Karam
(N)
H Kassim
(H)
J Lacotte
(J)
K Lahlou-Laforet
(K)
L Lamhaut
(L)
A Lanceleur
(A)
O Langeron
(O)
T Lavergne
(T)
E Lecarpentier
(E)
A Leenhardt
(A)
N Lellouche
(N)
V Lemiale
(V)
F Lemoine
(F)
F Linval
(F)
T Loeb
(T)
B Ludes
(B)
C E Luyt
(CE)
A Maltret
(A)
N Mansencal
(N)
N Mansouri
(N)
E Marijon
(E)
J Marty
(J)
E Maury
(E)
V Maxime
(V)
B Megarbane
(B)
A Mekontso-Dessap
(A)
H Mentec
(H)
J P Mira
(JP)
X Monnet
(X)
K Narayanan
(K)
N Ngoyi
(N)
M C Perier
(MC)
O Piot
(O)
R Pirracchio
(R)
P Plaisance
(P)
B Plaud
(B)
I Plu
(I)
J H Raphalen
(JH)
M Raux
(M)
F Revaux
(F)
J D Ricard
(JD)
C Richard
(C)
B Riou
(B)
F Roussin
(F)
F Santoli
(F)
F Schortgen
(F)
A Sharifzadehgan
(A)
T Sharshar
(T)
G Sideris
(G)
T Similowski
(T)
C Spaulding
(C)
J L Teboul
(JL)
J F Timsit
(JF)
J P Tourtier
(JP)
P Tuppin
(P)
C Ursat
(C)
O Varenne
(O)
A Vieillard-Baron
(A)
S Voicu
(S)
K Wahbi
(K)
V Waldmann
(V)
Informations de copyright
© 2022. The Author(s).
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