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Roncon-Albuquerque R, Gaião S, Figueiredo P, Príncipe N, Basílio C, Mergulhão P, Silva S, Honrado T, Cruz F, Pestana M, Oliveira G, Meira L, França A, Almeida-Sousa JP, Araújo F, Paiva JA. An integrated program of extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation and uncontrolled donation after circulatory determination of death in refractory cardiac arrest. Resuscitation 2018; 133:88-94. [PMID: 30321624 DOI: 10.1016/j.resuscitation.2018.10.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/10/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022]
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.
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Affiliation(s)
- Roberto Roncon-Albuquerque
- 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.
| | - Sérgio Gaião
- Department of Emergency and Intensive Care Medicine, São João Hospital Centre, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Portugal
| | - Paulo Figueiredo
- Department of Infectious Diseases, São João Hospital Centre, Porto, Portugal
| | - Nuno Príncipe
- Department of Emergency and Intensive Care Medicine, São João Hospital Centre, Porto, Portugal
| | - Carla Basílio
- Department of Emergency and Intensive Care Medicine, São João Hospital Centre, Porto, Portugal
| | - Paulo Mergulhão
- Department of Emergency and Intensive Care Medicine, São João Hospital Centre, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Portugal
| | - Sofia Silva
- Department of Emergency and Intensive Care Medicine, São João Hospital Centre, Porto, Portugal
| | - Teresa Honrado
- Department of Emergency and Intensive Care Medicine, São João Hospital Centre, Porto, Portugal
| | - Francisco Cruz
- 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
| | - Manuel Pestana
- 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
| | - Gerardo Oliveira
- Department of Medicine, Faculty of Medicine, University of Porto, Portugal; Organ Donation and Transplant Coordination Office, São João Hospital Centre, Porto, Portugal
| | - Luis Meira
- National Institute of Medical Emergency, Portugal
| | - Ana França
- Portuguese Institute for Blood and Transplantation, Portugal
| | | | | | - José-Artur Paiva
- Department of Emergency and Intensive Care Medicine, São João Hospital Centre, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Portugal
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