Organ donor potential after extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest – A post-hoc analysis of a randomized controlled trial
Hanne Verberght1, Thijs SR Delnoij 1, Martje M Suverein1, Jody Lunsing1, Renicus C Hermanides2, Luuk Otterspoor 3, Carlos V Elzo Kraemer 11, Alexander PJ Vlaar 4, Joris J van der Heijden5, Erik Scholten6, Corstiaan A den Uil7, Dinis dos Reis Miranda8, Sakir Akin9, Jesse de Metz10, Iwan CC van der Horst 1, Bas J Mathot8, Jeroen de Jonge8, Mijntje WM Nijboer11, Vincent E de Meijer12, Jan SF Sanders12, Maarten HL Christiaans1, Arjan D van Zuilen5, Hanneke Hagenaars8, Tineke Wind1, Miranda Danhof12, Steven Olde Damink1, Bjorn Winkens1, Jos G Maessen1, Roberto Lorusso 1, Marcel CG van de Poll1.
1 Department of Surgery, Intensive Care Medicine, Nephrology, Cardiothoracic Surgery, Statistics, Maastricht University Medical Center+, Maastricht, Netherlands; 2Department of Cardiology, Isala Clinics, Zwolle, Netherlands; 3Department of Intensive Care, Catharina Hospital, Eindhoven, Netherlands; 4Department of Intensive Care, Amsterdam University Medical Center location AMC, Amsterdam, Netherlands; 5Department of Intensive Care, Nephrology, University Medical Center Utrecht, Utrecht, Netherlands; 6Department of Intensive Care, St. Antonius Hospital, Nieuwegein, Netherlands; 7Department of Intensive Care, Maasstad Hospital, Rotterdam, Netherlands; 8Department of Intensive Care, Surgery, Pulmonary Medicine, Erasmus Medical Center, Rotterdam, Netherlands; 9Department of Intensive Care, Haga Hospital, The Hague, Netherlands; 10Department of Intensive Care, OLVG, Amsterdam, Netherlands; 11Department of Intensive Care, Surgery, Leiden University Medical Center, Leiden, Netherlands; 12Department of Surgery, Nephrology, University Medical Center Groningen, Groningen, Netherlands
the INCEPTION-investigators.
Background: Extracorporeal cardiopulmonary resuscitation (ECPR) is a potentially life-saving intervention in refractory out-of-hospital cardiac arrest (OHCA). ECPR enables, in most of the treated cases, ICU admission to patients who otherwise would have died at the emergency department (ED). Still, many of them die, frequently after withdrawal of life-sustaining therapies due to irreversible critical conditions and related complications. The additional time provided by ECPR, however, might allow for the assessment of organ donor suitability. The aim of this study was to evaluate the impact of ECPR on the number of potential organ donors after refractory OHCA.
Methods: We performed a post-hoc analysis of the multicenter INCEPTION trial, which randomized 134 OHCA patients between conventional CPR (CCPR) and ECPR. Detailed patient reports were presented to transplant physicians to determine the acceptability of the liver and kidneys for organ donation. In addition to the intention to treat analysis, we performed an “as-treated” analysis, limited to patients arriving without return of spontaneous circulation (ROSC) at the ED.
Results: Out of 70 patients randomized to ECPR and 64 to CCPR, potential organ donors were identified in 14 (20%) and 4 (6%) patients, respectively (χ² test, p=0.038). In the as-treated analysis, 15 out of 55 (27%) treated with ECPR were potential donors, compared to 0 out of 59 treated with CCPR (p<0.001). This included 5 (9%) potential kidney donors and 15 (27%) potential liver donors.
Conclusion: Although ECPR is currently used with life-saving intentions, it may simultaneously increase the number of potential organ donors following cardiac arrest in selected patients.
[1] Organ donation
[2] Extracorporeal Cardiopulmonary Resuscitation
[3] Out-of-hospital cardiac arrest