Out of hospital cardiac arrest and uncontrolled donation after circulatory death in a tertiary cardiac arrest center.

Abstract

Out of hospital cardiac arrest (OHCA) is worldwide quite a common disease, whose mortality still remains high. We aimed at assessing the number of potential donors after OHCA in a tertiary cardiac arrest center with extracorporeal membrane oxygenation (ECPR) and uncontrolled donation after circulatory death (uDCD) programs. In our single center, prospective, observational study (June 2016 to December 2018), we included all OHCA consecutive patients aged or less 65 years. Our series included 134 OHCA patients. The percentage of patients with return of spontaneous circulation (ROSC) was 36% (48/134). Among patients with no ROSC, ECPR was implanted in 26 patients (26/86, 30%). Among patients without ROSC, 25 patients were eligible for uDCD (25/86, 29%), while 35 patients died at the emergency department. Among patients with ROSC, 15 patients died (15/48, 31%), among whom seven became donors after brain death (7/15, 49%), a percentage which did not vary during the study period. In the subgroup of the 26 patients treated with ECPR, 24 patients died (24/26, 92%) among whom eight were potential donors (33%, 8/34), and only two patients survived (7.7%, 2/26) though with good neurological outcome. The implementation of ECPR and uDCD programs in a tertiary cardiac center is feasible and increased the number of donors, because despite organizational and technical challenges, the uDCD donor pool was 62.5% of all potential donors (25/40).