Abstract

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

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

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

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.

Details

Title
Organ donation after out-of-hospital cardiac arrest: a population-based study of data from the Paris Sudden Death Expertise Center
Author
Renaudier, M. 1 ; Binois, Y. 1 ; Dumas, F. 2 ; Lamhaut, L. 3 ; Beganton, F. 1 ; Jost, D. 4 ; Charpentier, J. 5 ; Lesieur, O. 6 ; Marijon, E. 7 ; Jouven, X. 7 ; Cariou, A. 8 ; Bougouin, W. 9 ; Adnet, F.; Agostinucci, J. M.; Aissaoui-Balanant, N.; Algalarrondo, V.; Alla, F.; Alonso, C.; Amara, W.; Annane, D.; Antoine, C.; Aubry, P.; Azoulay, E.; Billon, C.; Boutet, J.; Bruel, C.; Bruneval, P.; Carli, P.; Casalino, E.; Cerf, C.; Chaib, A.; Cholley, B.; Cohen, Y.; Combes, A.; Coulaud, J. M.; Crahes, M.; Da Silva, D.; Das, V.; Demoule, A.; Denjoy, I.; Deye, N.; Diehl, J. L.; Dinanian, S.; Domanski, L.; Dreyfuss, D.; Duboc, D.; Dubois-Rande, J. L.; Duranteau, J.; Empana, J. P.; Extramiana, F.; Fagon, J. Y.; Fartoukh, M.; Fieux, F.; Gabbas, M.; Gandjbakhch, E.; Geri, G.; Guidet, B.; Halimi, F.; Henry, P.; Hidden Lucet, F.; Jabre, P.; Joseph, L.; Karam, N. 10 ; Kassim, H.; Lacotte, J.; Lahlou-Laforet, K.; Lanceleur, A.; Langeron, O.; Lavergne, T. 10 ; Lecarpentier, E.; Leenhardt, A.; Lellouche, N.; Lemiale, V.; Lemoine, F.; Linval, F.; Loeb, T.; Ludes, B.; Luyt, C. E.; Maltret, A.; Mansencal, N.; Mansouri, N.; Marty, J.; Maury, E.; Maxime, V.; Megarbane, B.; Mekontso-Dessap, A.; Mentec, H.; Mira, J. P. 5 ; Monnet, X.; Narayanan, K.; Ngoyi, N.; Perier, M. C.; Piot, O.; Pirracchio, R.; Plaisance, P.; Plaud, B.; Plu, I.; Raphalen, J. H.; Raux, M.; Revaux, F.; Ricard, J. D.; Richard, C.; Riou, B.; Roussin, F.; Santoli, F.; Schortgen, F.; Sharifzadehgan, A. 10 ; Sharshar, T.; Sideris, G.; Similowski, T.; Spaulding, C. 10 ; Teboul, J. L.; Timsit, J. F.; Tourtier, J. P.; Tuppin, P.; Ursat, C.; Varenne, O.; Vieillard-Baron, A.; Voicu, S.; Wahbi, K.; Waldmann, V. 10 

1  Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France (GRID:grid.462416.3) (ISNI:0000 0004 0495 1460); Paris Sudden Death Expertise Center, Paris, France (GRID:grid.462416.3) 
2  Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France (GRID:grid.462416.3) (ISNI:0000 0004 0495 1460); Paris Sudden Death Expertise Center, Paris, France (GRID:grid.462416.3); Cochin-Hotel-Dieu Hospital, AP-HP, Emergency Department, Paris, France (GRID:grid.50550.35) (ISNI:0000 0001 2175 4109); Université de Paris, Paris, France (GRID:grid.508487.6) (ISNI:0000 0004 7885 7602) 
3  Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France (GRID:grid.462416.3) (ISNI:0000 0004 0495 1460); Paris Sudden Death Expertise Center, Paris, France (GRID:grid.462416.3); Université de Paris, Paris, France (GRID:grid.508487.6) (ISNI:0000 0004 7885 7602); Necker Enfants-Malades Hospital, Intensive Care Unit and SAMU 75, Paris, France (GRID:grid.412134.1) (ISNI:0000 0004 0593 9113) 
4  Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France (GRID:grid.462416.3) (ISNI:0000 0004 0495 1460); Paris Sudden Death Expertise Center, Paris, France (GRID:grid.462416.3); Brigade Des Sapeurs-Pompiers de Paris (BSPP), Paris, France (GRID:grid.477933.d) (ISNI:0000 0001 2201 2713) 
5  AP-HP, Cochin Hospital, Medical Intensive Care Unit, Paris Cedex 14, France (GRID:grid.411784.f) (ISNI:0000 0001 0274 3893) 
6  Université de Paris, Paris, France (GRID:grid.508487.6) (ISNI:0000 0004 7885 7602); Saint Louis General Hospital, Intensive Care Unit, La Rochelle, France (GRID:grid.508487.6) 
7  Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France (GRID:grid.462416.3) (ISNI:0000 0004 0495 1460); Paris Sudden Death Expertise Center, Paris, France (GRID:grid.462416.3); Université de Paris, Paris, France (GRID:grid.508487.6) (ISNI:0000 0004 7885 7602); European Georges Pompidou Hospital, AP-HP, Cardiology Department, Paris, France (GRID:grid.414093.b) (ISNI:0000 0001 2183 5849) 
8  Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France (GRID:grid.462416.3) (ISNI:0000 0004 0495 1460); Paris Sudden Death Expertise Center, Paris, France (GRID:grid.462416.3); Université de Paris, Paris, France (GRID:grid.508487.6) (ISNI:0000 0004 7885 7602); AP-HP, Cochin Hospital, Medical Intensive Care Unit, Paris Cedex 14, France (GRID:grid.411784.f) (ISNI:0000 0001 0274 3893) 
9  Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France (GRID:grid.462416.3) (ISNI:0000 0004 0495 1460); Paris Sudden Death Expertise Center, Paris, France (GRID:grid.462416.3); Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, Massy, France (GRID:grid.477415.4) 
10  European Georges Pompidou Hospital, AP-HP, Cardiology Department, Paris, France (GRID:grid.414093.b) (ISNI:0000 0001 2183 5849) 
Publication year
2022
Publication date
Dec 2022
Publisher
Springer Nature B.V.
e-ISSN
21105820
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1186/s13613-022-01023-7
ProQuest document ID
2673449380
Copyright
© The Author(s) 2022. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.