1
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Kim MJ, Lee DE, Kim JK, Yeo IH, Jung H, Kim JH, Jang TC, Lee SH, Park J, Kim D, Ryoo HW. Impact of the life-sustaining treatment decision act on organ donation in out-of-hospital cardiac arrests in South Korea: a multi-centre retrospective study. BMC Med Ethics 2024; 25:93. [PMID: 39223644 PMCID: PMC11367808 DOI: 10.1186/s12910-024-01090-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND The demand for organ transplants, both globally and in South Korea, substantially exceeds the supply, a situation that might have been aggravated by the enactment of the Life-Sustaining Treatment Decision Act (LSTDA) in February 2018. This legislation may influence emergency medical procedures and the availability of organs from brain-dead donors. This study aimed to assess LSTDA's impact, introduced in February 2018, on organ donation status in out-of-hospital cardiac arrest (OHCA) patients in a metropolitan city and identified related factors. METHODS We conducted a retrospective analysis of a regional cardiac arrest registry. This study included patients aged 16 or older with cardiac arrest and a cerebral performance category (CPC) score of 5 from January 2015 to December 2022. The exclusion criteria were CPC scores of 1-4, patients under 16 years, and patients declared dead or transferred from emergency departments. Logistic regression analysis was used to analyse factors affecting organ donation. RESULTS Of the 751 patients included in this study, 47 were organ donors, with a median age of 47 years. Before the LSTDA, there were 30 organ donations, which declined to 17 after its implementation. In the organ donation group, the causes of cardiac arrest included medical (34%), hanging (46.8%), and trauma (19.2%). The adjusted odds ratio for organ donation before the LSTDA implementation was 6.12 (95% CI 3.09-12.12), with non-medical aetiology as associated factors. CONCLUSION The enactment of the LSTDA in 2018 in South Korea may be linked to reduced organ donations among patients with OHCA, underscoring the need to re-evaluate the medical and legal aspects of organ donation, especially considering end-of-life care decisions.
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Affiliation(s)
- Min Jae Kim
- Department of Emergency Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Dong Eun Lee
- Department of Emergency Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
| | - Jong Kun Kim
- Department of Emergency Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - In Hwan Yeo
- Department of Emergency Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Haewon Jung
- Department of Emergency Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jung Ho Kim
- Department of Emergency Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Tae Chang Jang
- Department of Emergency Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sang-Hun Lee
- Department of Emergency Medicine, Keimyung University Dongsan Medical Center School of Medicine, Daegu, Korea
| | - Jinwook Park
- Department of Emergency Medicine, Daegu Fatima hospital, Daegu, Korea
| | - Deokhyeon Kim
- Daegu Emergency Medicine Collaboration Committee, Daegu, Korea
| | - Hyun Wook Ryoo
- Department of Emergency Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
- Daegu Emergency Medicine Collaboration Committee, Daegu, Korea
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2
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Senay B, Ibekwe E, Gokun Y, Elmer J, Hinduja A. Clinical Factors Associated With Mode of Death Following Cardiac Arrest. Am J Crit Care 2024; 33:290-297. [PMID: 38945819 DOI: 10.4037/ajcc2024145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
BACKGROUND Death after resuscitation from cardiac arrest is common. Although associated factors have been identified, knowledge about their relationship with specific modes of death is limited. OBJECTIVE To identify clinical factors associated with specific modes of death following cardiac arrest. METHODS This study involved a retrospective medical record review of patients admitted to a single health care center from January 2015 to March 2020 after resuscitation from cardiac arrest who died during their index hospitalization. Mode of death was categorized as either brain death, withdrawal of life-sustaining therapies due to neurologic causes, death due to medical causes, or withdrawal of life-sustaining therapies due to patient preference. Clinical characteristics across modes of death were compared. RESULTS The analysis included 731 patients. Death due to medical causes was the most common mode of death. Compared with the other groups of patients, those with brain death were younger, had fewer comorbidities, were more likely to have experienced unwitnessed and longer cardiac arrest, and had more severe acidosis and hyperglycemia on presentation. Patients who died owing to medical causes or withdrawal of life-sustaining therapies due to patient preference were older and had more comorbidities, fewer unfavorable cardiac arrest characteristics, and fewer days between cardiac arrest and death. CONCLUSIONS Significant associations were found between several clinical characteristics and specific mode of death following cardiac arrest. Decision-making regarding withdrawal of care after resuscitation from cardiac arrest should be based on a multimodal approach that takes account of a variety of personal and clinical factors.
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Affiliation(s)
- Blake Senay
- Blake Senay is a neurocritical care fellow, The Ohio State University, Columbus
| | - Elochukwu Ibekwe
- Elochukwu Ibekwe is a neurology resident, The Ohio State University, Columbus
| | - Yevgeniya Gokun
- Yevgeniya Gokun is a senior biostatistician, Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University
| | - Jonathan Elmer
- Jonathan Elmer is an associate professor, Department of Emergency Medicine, Critical Care Medicine, and Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Archana Hinduja
- Archana Hinduja is an associate professor, Department of Neurocritical Care, The Ohio State University
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Altomare M, Bekhor SS, Sacchi M, Ambrogi F, Infante G, Chieregato A, Pozzi F, Feo TMD, Nava L, Masturzo E, Prete LD, Perali C, Manzo E, Bertoli P, Virdis F, Spota A, Cioffi SPB, Benuzzi L, Santolamazza G, Podda M, Mingoli A, Chiara O, Cimbanassi S. How does damage control strategy influence organ's suitability for donation after major trauma? A multi-institutional study. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02488-w. [PMID: 38592467 DOI: 10.1007/s00068-024-02488-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/24/2024] [Indexed: 04/10/2024]
Affiliation(s)
- Michele Altomare
- Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
- Department of Acute Care Surgery and Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, Milano, 20162, Milan, Italy.
| | - Shir Sara Bekhor
- Department of Acute Care Surgery and Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, Milano, 20162, Milan, Italy
| | - Marco Sacchi
- Department EMERGENZA, URGENZA-E.A.S. SOREU Metropolitana, Via Campanini 6, 20124, Milan, Italy
| | - Federico Ambrogi
- Department of Clinical Science and Community Health, University of Milan, Festa del Perdono 7, 20122, Milan, Italy
| | - Gabriele Infante
- Department of Economics, Management and Quantitative Methods (DEMM), University of Milan, Via Festa del Perdono 7, Milan, Italy
- SSD Clinical Epidemiology and Trial Organization, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian 1, Milan, Italy
| | - Arturo Chieregato
- Neuro-intensive Care Unit, ASST Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Federico Pozzi
- Neuro-intensive Care Unit, ASST Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Tullia Maria De Feo
- UOC Trapianti Lombardia - NITp Fondazione IRCCS Ca', Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Lorenza Nava
- SS Coordinamento locale del prelievo di Organi e Tessuti, ASST Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Elisabetta Masturzo
- SS Coordinamento locale del prelievo di Organi e Tessuti, ASST Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Luca Del Prete
- General and Liver Transplantation Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122, Milan, Italy
| | - Carolina Perali
- General and Liver Transplantation Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122, Milan, Italy
| | - Elena Manzo
- ASST Fatebenefratelli Sacco, Piazza Principessa Clotilde 3, 20157, Milan, Italy
| | - Paolo Bertoli
- ASST Papa Giovanni XXIII, Piazza OMS - Organizzazione Mondiale della Sanità 1, 20147, Bergamo, Italy
| | - Francesco Virdis
- Department of Acute Care Surgery and Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, Milano, 20162, Milan, Italy
| | - Andrea Spota
- Department of Acute Care Surgery and Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, Milano, 20162, Milan, Italy
| | - Stefano Piero Bernardo Cioffi
- Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
- Department of Acute Care Surgery and Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, Milano, 20162, Milan, Italy
| | - Laura Benuzzi
- General Surgery Residency Program, University of Milan, Festa del Perdono 7, 20122, Milan, Italy
| | - Giuliano Santolamazza
- General Surgery Residency Program, University of Milan, Festa del Perdono 7, 20122, Milan, Italy
| | - Mauro Podda
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari, Cagliari, Italy
| | - Andrea Mingoli
- Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Osvaldo Chiara
- Department of Acute Care Surgery and Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, Milano, 20162, Milan, Italy
- Department of Medical-Surgical Physiopathology and Transplantation, University of Milan, Festa del Perdono 7, 20122, Milan, Italy
| | - Stefania Cimbanassi
- Department of Acute Care Surgery and Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, Milano, 20162, Milan, Italy
- Department of Medical-Surgical Physiopathology and Transplantation, University of Milan, Festa del Perdono 7, 20122, Milan, Italy
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4
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Dubourg Q, Savoye E, Drouin S, Legeai C, Barrou B, Rondeau E, Buob D, Kerbaul F, Bronchard R, Galichon P. Effect of Cardiac Arrest in Brain-dead Donors on Kidney Graft Function. Transplantation 2024; 108:768-776. [PMID: 37819189 DOI: 10.1097/tp.0000000000004825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Cardiac arrest (CA) causes renal ischemia in one-third of brain-dead kidney donors before procurement. We hypothesized that the graft function depends on the time interval between CA and organ procurement. METHODS We conducted a retrospective population-based study on a prospectively curated database. We included 1469 kidney transplantations from donors with a history of resuscitated CA in 2015-2017 in France. CA was the cause of death (primary CA) or an intercurrent event (secondary CA). The main outcome was the percentage of delayed graft function, defined by the use of renal replacement therapy within the first week posttransplantation. RESULTS Delayed graft function occurred in 31.7% of kidney transplantations and was associated with donor function, vasopressors, cardiovascular history, donor and recipient age, body mass index, cold ischemia time, and time to procurement after primary cardiac arrest. Short cold ischemia time, perfusion device use, and the absence of cardiovascular comorbidities were protected by multivariate analysis, whereas time <3 d from primary CA to procurement was associated with delayed graft function (odds ratio 1.38). CONCLUSIONS This is the first description of time to procurement after a primary CA as a risk factor for delayed graft function. Delaying procurement after CA should be evaluated in interventional studies.
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Affiliation(s)
- Quentin Dubourg
- Kidney Transplantation, APHP Sorbonne University, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emilie Savoye
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Sarah Drouin
- Kidney Transplantation, APHP Sorbonne University, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
- Common and Rare Kidney Diseases (CoRaKID) Unit, Institut National de la Santé and de la Recherche Médicale (INSERM) U1155, Paris, France
| | - Camille Legeai
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Benoit Barrou
- Kidney Transplantation, APHP Sorbonne University, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Eric Rondeau
- Kidney Transplantation, APHP Sorbonne University, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
- Common and Rare Kidney Diseases (CoRaKID) Unit, Institut National de la Santé and de la Recherche Médicale (INSERM) U1155, Paris, France
| | - David Buob
- Common and Rare Kidney Diseases (CoRaKID) Unit, Institut National de la Santé and de la Recherche Médicale (INSERM) U1155, Paris, France
- Department of Pathology, APHP Sorbonne University, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Francois Kerbaul
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Régis Bronchard
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Pierre Galichon
- Kidney Transplantation, APHP Sorbonne University, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
- Common and Rare Kidney Diseases (CoRaKID) Unit, Institut National de la Santé and de la Recherche Médicale (INSERM) U1155, Paris, France
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5
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Perman SM, Elmer J, Maciel CB, Uzendu A, May T, Mumma BE, Bartos JA, Rodriguez AJ, Kurz MC, Panchal AR, Rittenberger JC. 2023 American Heart Association Focused Update on Adult Advanced Cardiovascular Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2024; 149:e254-e273. [PMID: 38108133 DOI: 10.1161/cir.0000000000001194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Cardiac arrest is common and deadly, affecting up to 700 000 people in the United States annually. Advanced cardiac life support measures are commonly used to improve outcomes. This "2023 American Heart Association Focused Update on Adult Advanced Cardiovascular Life Support" summarizes the most recent published evidence for and recommendations on the use of medications, temperature management, percutaneous coronary angiography, extracorporeal cardiopulmonary resuscitation, and seizure management in this population. We discuss the lack of data in recent cardiac arrest literature that limits our ability to evaluate diversity, equity, and inclusion in this population. Last, we consider how the cardiac arrest population may make up an important pool of organ donors for those awaiting organ transplantation.
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6
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Alwesmi MB, Alharbi AI, Alsaiari AA, Abu Alreesh AE, Alasmari BA, Alanazi MA, Alanizi MK, Alsaif NM, Alanazi RM, Alshdayed SA, Alabbasi Y. The Role of Knowledge on Nursing Students' Attitudes toward Organ Donation: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:3134. [PMID: 38132024 PMCID: PMC10742546 DOI: 10.3390/healthcare11243134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/30/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Nursing students constitute the future nursing workforce; their knowledge can readily influence potential donors' decisions on organ donation. This study aimed to assess nursing students' knowledge of organ donation, determine its impact on their attitude, and identify relevant factors. METHODS A cross-sectional comparative study assessed the level of knowledge and attitude toward organ donation among nursing students using the following two questionnaires: (1) knowledge about organ donation and (2) attitudes toward posthumous organ donation. Non-probability convenience sampling was employed to collect data. RESULTS A total of 278 nursing students demonstrated a low level of knowledge on organ donation, with a score of 6.43 out of 15. This influenced their attitude toward organ donation (χ2 (3) = 33.91, p < 0.001). Nursing students who were willing to donate their organs showed higher knowledge (7.33 ± 3.23) compared to those who were not willing to donate their organs (5.21 ± 3.09), p < 0.001. Registered donors had higher knowledge (8.52 ± 2.99) than non-donors (5.80 ± 3.17), p < 0.001. CONCLUSIONS Even though nursing students typically favor organ donation, findings have revealed a low knowledge score. Therefore, it is necessary to improve knowledge of organ donation through nursing curricula and research, which could potentially increase the number of donors among future nursing students and, by extension, the broader population.
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Affiliation(s)
- Mai B. Alwesmi
- Department of Medical-Surgical Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia;
| | - Amirah Ibrahim Alharbi
- College of Nursing, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia; (A.I.A.); (A.A.A.); (B.A.A.); (M.A.A.); (M.K.A.); (N.M.A.); (R.M.A.); (S.A.A.)
| | - Amjad Abdullah Alsaiari
- College of Nursing, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia; (A.I.A.); (A.A.A.); (B.A.A.); (M.A.A.); (M.K.A.); (N.M.A.); (R.M.A.); (S.A.A.)
| | - Asalah Emad Abu Alreesh
- College of Nursing, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia; (A.I.A.); (A.A.A.); (B.A.A.); (M.A.A.); (M.K.A.); (N.M.A.); (R.M.A.); (S.A.A.)
| | - Bashair Abdullah Alasmari
- College of Nursing, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia; (A.I.A.); (A.A.A.); (B.A.A.); (M.A.A.); (M.K.A.); (N.M.A.); (R.M.A.); (S.A.A.)
| | - May Awad Alanazi
- College of Nursing, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia; (A.I.A.); (A.A.A.); (B.A.A.); (M.A.A.); (M.K.A.); (N.M.A.); (R.M.A.); (S.A.A.)
| | - May Khalil Alanizi
- College of Nursing, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia; (A.I.A.); (A.A.A.); (B.A.A.); (M.A.A.); (M.K.A.); (N.M.A.); (R.M.A.); (S.A.A.)
| | - Nouf Mohammed Alsaif
- College of Nursing, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia; (A.I.A.); (A.A.A.); (B.A.A.); (M.A.A.); (M.K.A.); (N.M.A.); (R.M.A.); (S.A.A.)
| | - Razan Mohammed Alanazi
- College of Nursing, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia; (A.I.A.); (A.A.A.); (B.A.A.); (M.A.A.); (M.K.A.); (N.M.A.); (R.M.A.); (S.A.A.)
| | - Sheikhah Abdullah Alshdayed
- College of Nursing, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia; (A.I.A.); (A.A.A.); (B.A.A.); (M.A.A.); (M.K.A.); (N.M.A.); (R.M.A.); (S.A.A.)
| | - Yasmine Alabbasi
- Department of Maternity and Child Health Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
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7
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Chan PS, Greif R, Anderson T, Atiq H, Bittencourt Couto T, Considine J, De Caen AR, Djärv T, Doll A, Douma MJ, Edelson DP, Xu F, Finn JC, Firestone G, Girotra S, Lauridsen KG, Kah-Lai Leong C, Lim SH, Morley PT, Morrison LJ, Moskowitz A, Mullasari Sankardas A, Mustafa Mohamed MT, Myburgh MC, Nadkarni VM, Neumar RW, Nolan JP, Odakha JA, Olasveengen TM, Orosz J, Perkins GD, Previdi JK, Vaillancourt C, Montgomery WH, Sasson C, Nallamothu BK. Ten Steps Toward Improving In-Hospital Cardiac Arrest Quality of Care and Outcomes. Resuscitation 2023; 193:109996. [PMID: 37942937 PMCID: PMC10769812 DOI: 10.1016/j.resuscitation.2023.109996] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Affiliation(s)
- Paul S Chan
- Mid-America Heart Institute, Kansas City, MO, United States.
| | - Robert Greif
- Department of Anesthesiology and Pain Medicine, University of Bern, Switzerland
| | - Theresa Anderson
- Department of Internal Medicine, University of Michigan Medical, Ann Arbor, United States
| | - Huba Atiq
- Centre of Excellence for Trauma and Emergencies, Aga Khan University Hospital, Pakistan
| | | | | | - Allan R De Caen
- Division of Pediatric Critical Care, Stollery Children's Hospital, Edmonton, Canada
| | - Therese Djärv
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Ann Doll
- Global Resuscitation Alliance, Seattle, WA, United States
| | - Matthew J Douma
- Department of Critical Care Medicine, University of Alberta, Canada
| | - Dana P Edelson
- Department of Medicine, University of Chicago Medicine, IL, United States
| | - Feng Xu
- Department of Emergency Medicine, Qilu Hospital of Shandong University, China
| | - Judith C Finn
- School of Nursing, Curtin University, Perth, Australia
| | - Grace Firestone
- Department of Family Medicine, University of California Los Angeles Health, Santa Monica, United States
| | - Saket Girotra
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, United States
| | | | | | - Swee Han Lim
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Peter T Morley
- Department of Intensive Care, The University of Melbourne, Australia
| | - Laurie J Morrison
- Division of Emergency Medicine, University of Toronto, Ontario, Canada
| | - Ari Moskowitz
- Department of Medicine, Montefiore Medical Center, The Bronx, NY, United States
| | | | | | | | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care, Childrens Hospital of Philadelphia, PA, United States
| | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan, Ann Arbor, United States
| | | | | | - Theresa M Olasveengen
- Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Judit Orosz
- Department of Medicine, The Alfred, Melbourne, Australia
| | | | | | | | | | | | - Brahmajee K Nallamothu
- Department of Internal Medicine, University of Michigan Medical, Ann Arbor, United States
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8
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Nallamothu BK, Greif R, Anderson T, Atiq H, Couto TB, Considine J, De Caen AR, Djärv T, Doll A, Douma MJ, Edelson DP, Xu F, Finn JC, Firestone G, Girotra S, Lauridsen KG, Leong CKL, Lim SH, Morley PT, Morrison LJ, Moskowitz A, Mullasari Sankardas A, Mohamed MTM, Myburgh MC, Nadkarni VM, Neumar RW, Nolan JP, Athieno Odakha J, Olasveengen TM, Orosz J, Perkins GD, Previdi JK, Vaillancourt C, Montgomery WH, Sasson C, Chan PS. Ten Steps Toward Improving In-Hospital Cardiac Arrest Quality of Care and Outcomes. Circ Cardiovasc Qual Outcomes 2023; 16:e010491. [PMID: 37947100 PMCID: PMC10659256 DOI: 10.1161/circoutcomes.123.010491] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
| | - Robert Greif
- Department of Anesthesiology and Pain Medicine, University of Bern, Switzerland (R.G.)
| | - Theresa Anderson
- Department of Internal Medicine, University of Michigan Medical, Ann Arbor (B.K.N., T.A.)
| | - Huba Atiq
- Centre of Excellence for Trauma and Emergencies, Aga Khan University Hospital, Pakistan (H.A.)
| | | | | | - Allan R. De Caen
- Division of Pediatric Critical Care, Stollery Children’s Hospital, Edmonton, Canada (A.R.D.C.)
| | - Therese Djärv
- Department of Medicine, Karolinska Institute, Stockholm, Sweden (T.D.)
| | - Ann Doll
- Global Resuscitation Alliance, Seattle, WA (A.D.)
| | - Matthew J. Douma
- Department of Critical Care Medicine, University of Alberta, Canada (M.J.D.)
| | - Dana P. Edelson
- Department of Medicine, University of Chicago Medicine, IL (D.P.E.)
| | - Feng Xu
- Department of Emergency Medicine, Qilu Hospital of Shandong University, China (F.X.)
| | - Judith C. Finn
- School of Nursing, Curtin University, Perth, Australia (J.F.)
| | - Grace Firestone
- Department of Family Medicine, University of California Los Angeles Health, Santa Monica (G.F.)
| | - Saket Girotra
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas (S.G.)
| | | | - Carrie Kah-Lai Leong
- Department of Emergency Medicine, Singapore General Hospital (C.K.-L.L., S.H.L.)
| | - Swee Han Lim
- Department of Emergency Medicine, Singapore General Hospital (C.K.-L.L., S.H.L.)
| | - Peter T. Morley
- Department of Intensive Care, The University of Melbourne, Australia (P.T.M.)
| | - Laurie J. Morrison
- Division of Emergency Medicine, University of Toronto, Ontario, Canada (L.J.M.)
| | - Ari Moskowitz
- Department of Medicine, Montefiore Medical Center, The Bronx, NY (A.M.)
| | | | | | | | - Vinay M. Nadkarni
- Department of Anesthesiology and Critical Care, Childrens Hospital of Philadelphia, PA (V.N.)
| | - Robert W. Neumar
- Department of Emergency Medicine, University of Michigan, Ann Arbor (R.W.N.)
| | - Jerry P. Nolan
- University of Warwick, Coventry, United Kingdom (J.P.N., G.D.P.)
| | | | - Theresa M. Olasveengen
- Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway (T.M.O.)
| | - Judit Orosz
- Department of Medicine, The Alfred, Melbourne, Australia (J.O.)
| | - Gavin D. Perkins
- University of Warwick, Coventry, United Kingdom (J.P.N., G.D.P.)
| | | | | | | | | | - Paul S. Chan
- Mid-America Heart Institute, Kansas City, MO (P.S.C.)
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9
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Kitlen E, Kim N, Rubenstein A, Keenan C, Garcia G, Khosla A, Johnson J, Miller PE, Wira C, Greer D, Gilmore EJ, Beekman R. Development and validation of a novel score to predict brain death after out-of-hospital cardiac arrest. Resuscitation 2023; 192:109955. [PMID: 37661012 DOI: 10.1016/j.resuscitation.2023.109955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/21/2023] [Accepted: 08/27/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Brain death (BD) occurs in 9-24% of successfully resuscitated out-of-hospital cardiac arrests (OHCA). To predict BD after OHCA, we developed a novel brain death risk (BDR) score. METHODS We identified independent predictors of BD after OHCA in a retrospective, single academic center cohort between 2011 and 2021. The BDR score ranges from 0 to 7 points and includes: non-shockable rhythm (1 point), drug overdose as etiology of arrest (1 point), evidence of grey-white differentiation loss or sulcal effacement on head computed tomography (CT) radiology report within 24 hours of arrest (2 points), Full-Outline-Of-UnResponsiveness (FOUR) score of 0 (2 points), FOUR score 1-5 (1 point), and age <45 years (1 point). We internally validated the BDR score using k-fold cross validation (k = 8) and externally validated the score at an independent academic center. The main outcome was BD. RESULTS The development cohort included 362OHCA patients, of whom 18% (N = 58) experienced BD. Internal validation provided an area under the receiving operator characteristic curve (AUC) (95% CI) of 0.931 (0.905-0.957). In the validation cohort, 19.8% (N = 17) experienced BD. The AUC (95% CI) was 0.849 (0.765-0.933). In both cohorts, a BDR score >4 was the optimal cut off (sensitivity 0.903 and 0.882, specificity 0.830 and 0.652, in the development and validation cohorts respectively). DISCUSSION The BDR score identifies those at highest risk for BD after OHCA. Our data suggest that a BDR score >4 is the optimal cut off.
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Affiliation(s)
- Eva Kitlen
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Noah Kim
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Alexandra Rubenstein
- Department of Neurology, Boston University Medical Center, Boston, MA, United States
| | - Caitlyn Keenan
- Department of Neurology, Boston University Medical Center, Boston, MA, United States
| | - Gabriella Garcia
- Department of Neurology, University of Pennsylvania, PA, United States
| | - Akhil Khosla
- Department of Pulmonary Critical Care, Yale School of Medicine, New Haven, CT, United States
| | | | - P Elliott Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Charles Wira
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
| | - David Greer
- Department of Neurology, Boston University Medical Center, Boston, MA, United States
| | - Emily J Gilmore
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Rachel Beekman
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States.
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10
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Cotter EKH, Jacobs M, Jain N, Chow J, Estimé SR. Post-cardiac arrest care in the intensive care unit. Int Anesthesiol Clin 2023; 61:71-78. [PMID: 37678200 DOI: 10.1097/aia.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Affiliation(s)
- Elizabeth K H Cotter
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Matthew Jacobs
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, Illinois
| | - Nisha Jain
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, Illinois
| | - Jarva Chow
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, Illinois
| | - Stephen R Estimé
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, Illinois
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11
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Jensen CW, Jawitz OK, Benkert AR, Spencer PJ, Bryner BS, Schroder JN, Milano CA. Cardiovascular mechanism of donor brain death and heart recipient survival. J Card Surg 2022; 37:4621-4627. [PMID: 36378929 DOI: 10.1111/jocs.17150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/25/2022] [Accepted: 10/02/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heart donation after donor brain death from cardiac arrest despite successful resuscitation may be associated with worse recipient outcomes due to potential graft ischemia or underlying rhythmic/structural defects. However, selected grafts from such donors often have normal cardiac function and anatomy. We investigated whether a cardiovascular mechanism of donor brain death (CV-DBD) was associated with worse recipient outcomes. METHODS We queried the United Network for Organ Sharing (UNOS) database for first-time, single-organ, adult (age 18+) heart transplant recipients and their associated donors between January 2005 and March 2021. Recipients were stratified by donor status (CV-DBD vs. non-CV-DBD). We performed multivariable Cox proportional hazards modeling to ascertain whether receiving a CV-DBD graft was independently associated with mortality. RESULTS Of 35,833 included recipients, 2,702 (7.5%) received CV-DBD grafts. The associated donors were significantly more likely to be female, older, and have a history of diabetes, hypertension, and substance use (all p < .001). On unadjusted Kaplan-Meier analysis, CV-DBD recipients had a significantly reduced median survival than non-CV-DBD recipients (12.0 vs. 13.1 years, log-rank p = .04). However, after adjusting for donor/recipient age, recipient comorbidities, annualized center volume, and transplantation era, CV-DBD organ status was not associated with recipient mortality (hazard ratio: 1.05, 95% confidence interval: 0.96-1.13, p = .28). CONCLUSION In this analysis of over 35,000 heart transplants, CV-DBD status was not associated with adjusted recipient survival. Donor brain death due to cardiac arrest should not be an absolute contraindication to heart donation, although graft function should be carefully assessed before transplantation.
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Affiliation(s)
- Christopher W Jensen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Oliver K Jawitz
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Clinical Research Institute, Duke University Health System, Durham, North Carolina, USA
| | - Abigail R Benkert
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Philip J Spencer
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Benjamin S Bryner
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jacob N Schroder
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Carmelo A Milano
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
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12
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Coppler PJ, Flickinger KL, Darby JM, Doshi A, Guyette FX, Faro J, Callaway CW, Elmer J. Early risk stratification for progression to death by neurological criteria following out-of-hospital cardiac arrest. Resuscitation 2022; 179:248-255. [PMID: 35914657 DOI: 10.1016/j.resuscitation.2022.07.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/27/2022] [Accepted: 07/22/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Some patients resuscitated from out-of-hospital cardiac arrest (OHCA) progress to death by neurological criteria (DNC). We hypothesized that initial brain imaging, electroencephalography (EEG), and arrest characteristics predict progression to DNC. METHODS We identified comatose OHCA patients from January 2010 to February 2020 treated at a single quaternary care facility in Western Pennsylvania. We abstracted demographics and arrest characteristics; Pittsburgh Cardiac Arrest Category, initial motor exam and pupillary light reflex; initial brain computed tomography (CT) grey-to-white ratio (GWR), sulcal or basal cistern effacement; initial EEG background and suppression ratio. We used two modeling approaches: fast and frugal tree (FFT) analysis to create an interpretable clinical risk stratification tool and ridge regression for comparison. We used bootstrapping to randomly partition cases into 80% training and 20% test sets and evaluated test set sensitivity and specificity. RESULTS We included 1,569 patients, of whom 147 (9%) had diagnosed DNC. Across bootstrap samples, >99% of FFTs included three predictors: sulcal effacement, and in cases without sulcal effacement, the combination of EEG background suppression and GWR ≤ 1.23. This tree had mean sensitivity and specificity of 87% and 81%. Ridge regression with all available predictors had mean sensitivity 91 % and mean specificity 83%. Subjects falsely predicted as likely to progress to DNC generally died of rearrest or withdrawal of life sustaining therapies due to poor neurological prognosis. Two of these cases awakened from coma during the index hospitalization. CONCLUSIONS Sulcal effacement on presenting brain CT or EEG suppression with GWR ≤ 1.23 predict progression to DNC after OHCA.
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Affiliation(s)
- Patrick J Coppler
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| | | | - Joseph M Darby
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ankur Doshi
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Francis X Guyette
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - John Faro
- Department of Family Medicine, Soin Medical Center - Kettering Health Network, Beavercreek, OH, USA
| | - Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
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13
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Early brain imaging after cardiac arrest: Beware the red flags. Resuscitation 2022; 176:88-89. [PMID: 35691530 DOI: 10.1016/j.resuscitation.2022.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 11/22/2022]
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14
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Renaudier M, Binois Y, Dumas F, Lamhaut L, Beganton F, Jost D, Charpentier J, Lesieur O, Marijon E, Jouven X, Cariou A, Bougouin W. Organ donation after out-of-hospital cardiac arrest: a population-based study of data from the Paris Sudden Death Expertise Center. Ann Intensive Care 2022; 12:48. [PMID: 35666323 PMCID: PMC9170852 DOI: 10.1186/s13613-022-01023-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
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.
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Affiliation(s)
- M Renaudier
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France.,Paris Sudden Death Expertise Center, Paris, France
| | - Y Binois
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France.,Paris Sudden Death Expertise Center, Paris, France
| | - F Dumas
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France.,Paris Sudden Death Expertise Center, Paris, France.,Emergency Department, Cochin-Hotel-Dieu Hospital, AP-HP, Paris, France.,Université de Paris, Paris, France
| | - L Lamhaut
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France.,Paris Sudden Death Expertise Center, Paris, France.,Université de Paris, Paris, France.,Intensive Care Unit and SAMU 75, Necker Enfants-Malades Hospital, Paris, France
| | - F Beganton
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France.,Paris Sudden Death Expertise Center, Paris, France
| | - D Jost
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France.,Paris Sudden Death Expertise Center, Paris, France.,Brigade Des Sapeurs-Pompiers de Paris (BSPP), Paris, France
| | - J Charpentier
- Medical Intensive Care Unit, AP-HP, Cochin Hospital, Paris Cedex 14, France
| | - O Lesieur
- Université de Paris, Paris, France.,Intensive Care Unit, Saint Louis General Hospital, La Rochelle, France
| | - E Marijon
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France.,Paris Sudden Death Expertise Center, Paris, France.,Université de Paris, Paris, France.,Cardiology Department, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - X Jouven
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France.,Paris Sudden Death Expertise Center, Paris, France.,Université de Paris, Paris, France.,Cardiology Department, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - A Cariou
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France. .,Paris Sudden Death Expertise Center, Paris, France. .,Université de Paris, Paris, France. .,Medical Intensive Care Unit, AP-HP, Cochin Hospital, Paris Cedex 14, France.
| | - W Bougouin
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France.,Paris Sudden Death Expertise Center, Paris, France.,Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, Massy, France
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15
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Benghanem S, Cariou A. Organ donation after resuscitation: Towards a regionalization of cardiac arrest centers? Resuscitation 2021; 167:417-418. [PMID: 34480976 DOI: 10.1016/j.resuscitation.2021.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Sarah Benghanem
- Medical Intensive Care Unit, Cochin University Hospital (APHP), Paris, France; University of Paris - Medical School, Paris, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin University Hospital (APHP), Paris, France; University of Paris - Medical School, Paris, France.
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16
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Between-hospital variability in organ donation after resuscitation from out-of-hospital cardiac arrest. Resuscitation 2021; 167:372-379. [PMID: 34363855 DOI: 10.1016/j.resuscitation.2021.07.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 07/15/2021] [Accepted: 07/22/2021] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Survival and recovery after out-of-hospital cardiac arrest (OHCA) varies between hospitals, with better outcomes associated with high-volume and specialty care. We evaluated if there is a similar relationship with organ donation after OHCA. METHODS We studied a cohort of adults resuscitated from OHCA from 2010 to 2018, treated at one of 112 hospitals served by a regional organ procurement organization (OPO). We obtained hospital-level characteristics from Centers for Medicare and Medicaid Services and Health Resources and Services Administration and obtained patients' clinical information from the OPO health record. We excluded patients with no potential to donate on initial referral. Our primary exposure was treatment at a high-volume hospital (defined >500 eligible cases during the study period) and our primary outcomes were suitability to donate after full medical evaluation, successful organ procurement and organ transplantation. We used mixed effects models to quantify between-hospital variability in the primary outcomes RESULTS: Overall, 9,792 patients were included and 796 (8%) were organ donors. We identified significant between-hospital variation in odds of donation (median odds ratio 1.64 [95% CI 1.42 - 2.02]). Hospital volume explained the greatest proportion of variability. High volume centers had a higher proportion of referrals with potential to donate (16.9 vs 12.2%), actual donation (10.3 vs 6.2%), and successful transplantation (9.4 vs 5.7%). Overall, 2032/7763 (26%) of recovered transplantable organs in this region were procured from OHCA patients. CONCLUSION High volume centers are more likely to refer and procure transplantable organs from patients with non-survivable OHCA.
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17
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Resuscitation highlights in 2019. Resuscitation 2020; 148:234-241. [DOI: 10.1016/j.resuscitation.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 02/02/2020] [Indexed: 11/22/2022]
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