Three markers allow early identification of donor organs after cardiac arrest
medwireNews: Researchers have identified three simple, objective criteria that can identify patients with “essentially no chance of survival” after out-of-hospital cardiac arrest.
The three markers are unwitnessed cardiac arrest, a nonshockable initial cardiac rhythm and no return of spontaneous circulation before receipt of the third 1 mg dose of epinephrine.
None of the 772 patients enrolled in the Paris Sudden Death Expertise Center (SDEC) cohort over a 1-year period who met all three of these criteria were discharged from hospital alive, compared with 14% of the 999 patients who met two or fewer of the criteria.
Among an additional 3656 patients enrolled over the following 2 years, one patient who met the criteria was discharged in a persistent vegetative state, with all others dying, compared with 16% of the other patients. And the results were the same in about 1500 patients from two external validation cohorts, with no survivors among those who met all three criteria, compared with up to 27% of other patients.
Xavier Jouven (Hôpital Européen Georges Pompidou, Paris, France) and co-researchers caution, however, that several patients were excluded because of missing outcome data, leaving open the possibility of survivors among patients meeting the three criteria.
“However, the results of the sensitivity analyses that included these patients were consistent with the results of the main analyses”, they write in the Annals of Internal Medicine.
The researchers stress that resuscitation of the patient should always be the first aim in out-of-hospital cardiac arrest, with organ donation considered only when available therapeutic options have been exhausted.
On the other hand, they note that the requirement for 30 minutes of attempted on-site resuscitation in France may be behind the reported need to discard some donor organs.
“A rapid medical decision to transport patients for organ donation with ongoing resuscitation efforts based on these reliable and objective criteria could result in reaching the hospital earlier”, they say, noting that organ donation itself is an “emergency procedure with specific time constraints”, and that it “requires highly coordinated multidisciplinary teamwork to preserve organ function.”
The external Paris SDEC cohort contained 122 (8%) patients with no chance of survival who had organs potentially suitable for donation, say Jouven et al, although they add that, in practice, around a third of theoretically suitable organs are discarded for medical reasons.
medwireNews is an independent medical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2016
Ann Intern Med 2016; Advance online publication