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Resuscitation. 2018 Dec;133:88-94. doi: 10.1016/j.resuscitation.2018.10.016. Epub 2018 Oct 13.

An integrated program of extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation and uncontrolled donation after circulatory determination of death in refractory cardiac arrest.

Author information

1
Department of Emergency and Intensive Care Medicine, São João Hospital Centre, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal. Electronic address: rra_jr@yahoo.com.
2
Department of Emergency and Intensive Care Medicine, São João Hospital Centre, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Portugal.
3
Department of Infectious Diseases, São João Hospital Centre, Porto, Portugal.
4
Department of Emergency and Intensive Care Medicine, São João Hospital Centre, Porto, Portugal.
5
Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal; Department of Urology, São João Hospital Centre, Porto, Portugal; i3S: Instituto de Investigação e Inovação em Saúde, Portugal.
6
Department of Medicine, Faculty of Medicine, University of Porto, Portugal; Department of Nephrology, São João Hospital Centre, Porto, Portugal; Nephrology and Infectious Diseases R&D Group, Instituto de Investigação e Inovação em Saúde (INEB-i3S), Universidade do Porto, Portugal.
7
Department of Medicine, Faculty of Medicine, University of Porto, Portugal; Organ Donation and Transplant Coordination Office, São João Hospital Centre, Porto, Portugal.
8
National Institute of Medical Emergency, Portugal.
9
Portuguese Institute for Blood and Transplantation, Portugal.
10
Ministry of Health, Portugal.

Abstract

AIM:

To assess the feasibility of an integrated program of extracorporeal cardiopulmonary resuscitation (ECPR) and uncontrolled donation after circulatory determination of death (uDCDD) in refractory cardiac arrest (rCA).

METHODS:

Single center, prospective, observational study of selected patients with in-hospital (IHCA) and out-of-hospital (OHCA) rCA occurring in an urban area of ∼1.5 million inhabitants, between October-2016 and May-2018. 65 year old or younger patients without significant bleeding or comorbidities with witnessed nonasystolic cardiac arrests were triaged to ECPR if they had a reversible cause and high quality CPR lasting < 60 min. Otherwise they were considered for uDCDD after a ten minute no touch period using normothermic regional perfusion.

RESULTS:

58 patients were included, of which 41 (71%) were OHCA and 18 (31%) had ECPR initiated. Median age was 52 (IQR 45-56) years. Cannulation was successful in 49/58 (84%) cases. Compared to ECPR, patients referred for uDCDD were more frequently OHCA (90 vs. 28%), had bystander CPR (28 vs. 83%) and prolonged low-flow period (40 (35-50) vs. 60 (49-78) min). Survival to hospital discharge with full neurological recovery (cerebral performance category 1) occurred in 6/18 (33%) ECPR patients. uDCDD resulted in transplantation of 44 kidneys.

CONCLUSIONS:

An integrated program for rCA consisting of a formal pathway to uDCDD referral in ECPR ineligible patients is feasible. ECPR-referred patients had a reasonable survival with full neurologic recovery. Successful kidney transplantation was achieved with uDCDD.

KEYWORDS:

ECMO assisted cardiopulmonary resuscitation; Extracorporeal membrane oxygenation (ECMO); Refractory cardiac arrest; Uncontrolled donation after circulatory determination of death (uDCDD)

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