1
|
Renaudier M, Binois Y, Dumas F, Lamhaut L, Beganton F, Jost D, Charpentier J, Lesieur O, Marijon E, Jouven X, Cariou A, Bougouin W. Controlled donation after circulatory death in post-cardiac arrest patients: Estimates from a large registry. Resuscitation 2024; 199:110202. [PMID: 38582445 DOI: 10.1016/j.resuscitation.2024.110202] [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: 01/18/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Controlled donation after circulatory death (cDCD) in post-anoxic brain injury is a valuable source of organs that is still underused in some countries. We assessed the number of potential cDCD donors after out-of-hospital cardiac arrest (OHCA) in Paris and its suburbs and extrapolated the results to the French population. METHODS Using the large regional registry of the Great Paris area, we prospectively included all consecutive adults with OHCA with a stable return of spontaneous circulation (ROSC) who ultimately died in the intensive care unit (ICU) after withdrawal of life-sustaining treatments (WLST) due to post anoxic brain injury. The primary endpoint was potential for organ donation by cDCD in this population. The number of potential cDCD donors was calculated and extrapolated to the entire French population. RESULTS Between 2011 and 2018, 4638 patients with stable ROSC were admitted to ICUs after OHCA, and 3170 died in ICU, of which 1034 died after WLST due to post-anoxic brain injury. When considering French criteria, 421/1034 patients (41%) would have been potential cDCD donors (55 patients per year in a 4.67 million population). After standardization for age and sex, the potential for cDCD was 515 (95% CI 471-560) patients per year in France corresponding to an annual incidence of 1.18 per 100 000 inhabitants per year. CONCLUSIONS Organ donation by cDCD after cardiac arrest could provide a large pool of donors in France.
Collapse
Affiliation(s)
- Marie Renaudier
- Paris Cardiovascular Research Centre (PARCC), INSERM Unit 970, Paris, France; Paris Sudden Death Expertise Centre, Paris, France; Université Paris Cité, Paris, France; Intensive Care Unit, Cochin-Hotel-Dieu Hospital, AP-HP, Paris, France.
| | - Yannick Binois
- Paris Cardiovascular Research Centre (PARCC), INSERM Unit 970, Paris, France; Paris Sudden Death Expertise Centre, Paris, France
| | - Florence Dumas
- Paris Cardiovascular Research Centre (PARCC), INSERM Unit 970, Paris, France; Paris Sudden Death Expertise Centre, Paris, France; Emergency Department, Cochin-Hotel-Dieu Hospital, AP-HP, Paris, France; Université Paris Cité, Paris, France
| | - Lionel Lamhaut
- Paris Cardiovascular Research Centre (PARCC), INSERM Unit 970, Paris, France; Paris Sudden Death Expertise Centre, Paris, France; Université Paris Cité, Paris, France; Intensive Care Unit and SAMU 75, Necker Enfants-Malades Hospital, Paris, France
| | - Frankie Beganton
- Paris Cardiovascular Research Centre (PARCC), INSERM Unit 970, Paris, France; Paris Sudden Death Expertise Centre, Paris, France
| | - Daniel Jost
- Paris Cardiovascular Research Centre (PARCC), INSERM Unit 970, Paris, France; Paris Sudden Death Expertise Centre, Paris, France; Brigade des Sapeurs-Pompiers de Paris (BSPP), Paris, France
| | - Julien Charpentier
- Donor Coordinator Unit, Cochin-Hotel-Dieu Hospital, AP-HP, Paris, France; Intensive Care Unit, Cochin-Hotel-Dieu Hospital, AP-HP, Paris, France
| | - Olivier Lesieur
- Université Paris Cité, Paris, France; Intensive Care Unit, Saint Louis General Hospital, La Rochelle, France
| | - Eloi Marijon
- Paris Cardiovascular Research Centre (PARCC), INSERM Unit 970, Paris, France; Paris Sudden Death Expertise Centre, Paris, France; Université Paris Cité, Paris, France; Cardiology Department, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - Xavier Jouven
- Paris Cardiovascular Research Centre (PARCC), INSERM Unit 970, Paris, France; Paris Sudden Death Expertise Centre, Paris, France; Université Paris Cité, Paris, France; Cardiology Department, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - Alain Cariou
- Paris Cardiovascular Research Centre (PARCC), INSERM Unit 970, Paris, France; Paris Sudden Death Expertise Centre, Paris, France; Université Paris Cité, Paris, France; Intensive Care Unit, Cochin-Hotel-Dieu Hospital, AP-HP, Paris, France
| | - Wulfran Bougouin
- Paris Cardiovascular Research Centre (PARCC), INSERM Unit 970, Paris, France; Paris Sudden Death Expertise Centre, Paris, France; Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, France
| |
Collapse
|
2
|
Lawson B, Williams B. Identifying organ donors attended by prehospital healthcare professionals - A scoping review. Int Emerg Nurs 2024; 74:101448. [PMID: 38703620 DOI: 10.1016/j.ienj.2024.101448] [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: 08/29/2023] [Revised: 02/27/2024] [Accepted: 03/26/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Organ donation is a life-saving intervention that provides hope for patients with end-stage organ failure, improving their longevity and quality of life. However, the demand for organs far exceeds the supply, leading to a significant disparity between patients on transplant waiting lists and the availability of suitable organs. To address this issue, innovative strategies, such as uncontrolled donation after circulatory death (uDCD) programs, have been proposed to expand the donor pool to the prehospital setting. AIM This study aimed to systematically map the literature and comprehensively evaluate the involvement of prehospital healthcare professionals in identifying potential organ donors, as well as the barriers and systems impacting this process. METHODS A scoping literature review was conducted guided by the PRISMA Extension for Scoping Reviews. Four electronic databases and grey literature were searched for articles examining the participation of prehospital healthcare professionals in the organ or tissue donation process. Relevant data were extracted, organised into narrative and tabular formats, and presented. RESULTS A total of 33 articles were included for analysis, predominantly focusing on uDCD programs. The review identified a limited evidence-base regarding the role of prehospital healthcare professionals in organ donation. Four common themes emerged: discrepancies in criteria, decision-making processes, bridging strategies, and ethical considerations. CONCLUSION This scoping literature review highlights the significant role of prehospital healthcare professionals in identifying and recruiting organ donors from non-traditional settings. Established uDCD systems show promise in alleviating the burden on transplant waitlists. However, there is a lack of consensus on enrolment criteria, transportation, and ethical considerations for uDCD. Further research is needed to address these gaps, establish evidence-based guidelines, and ensure the efficient and ethical utilisation of potential organ donors from unconventional settings.
Collapse
Affiliation(s)
- Ben Lawson
- Department of Paramedicine, Monash University, Victoria, Australia.
| | - Brett Williams
- Department of Paramedicine, Monash University, Victoria, Australia
| |
Collapse
|
3
|
Marijon E, Narayanan K, Smith K, Barra S, Basso C, Blom MT, Crotti L, D'Avila A, Deo R, Dumas F, Dzudie A, Farrugia A, Greeley K, Hindricks G, Hua W, Ingles J, Iwami T, Junttila J, Koster RW, Le Polain De Waroux JB, Olasveengen TM, Ong MEH, Papadakis M, Sasson C, Shin SD, Tse HF, Tseng Z, Van Der Werf C, Folke F, Albert CM, Winkel BG. The Lancet Commission to reduce the global burden of sudden cardiac death: a call for multidisciplinary action. Lancet 2023; 402:883-936. [PMID: 37647926 DOI: 10.1016/s0140-6736(23)00875-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/13/2023] [Accepted: 04/25/2023] [Indexed: 09/01/2023]
Abstract
Despite major advancements in cardiovascular medicine, sudden cardiac death (SCD) continues to be an enormous medical and societal challenge, claiming millions of lives every year. Efforts to prevent SCD are hampered by imperfect risk prediction and inadequate solutions to specifically address arrhythmogenesis. Although resuscitation strategies have witnessed substantial evolution, there is a need to strengthen the organisation of community interventions and emergency medical systems across varied locations and health-care structures. With all the technological and medical advances of the 21st century, the fact that survival from sudden cardiac arrest (SCA) remains lower than 10% in most parts of the world is unacceptable. Recognising this urgent need, the Lancet Commission on SCD was constituted, bringing together 30 international experts in varied disciplines. Consistent progress in tackling SCD will require a completely revamped approach to SCD prevention, with wide-sweeping policy changes that will empower the development of both governmental and community-based programmes to maximise survival from SCA, and to comprehensively attend to survivors and decedents' families after the event. International collaborative efforts that maximally leverage and connect the expertise of various research organisations will need to be prioritised to properly address identified gaps. The Commission places substantial emphasis on the need to develop a multidisciplinary strategy that encompasses all aspects of SCD prevention and treatment. The Commission provides a critical assessment of the current scientific efforts in the field, and puts forth key recommendations to challenge, activate, and intensify efforts by both the scientific and global community with new directions, research, and innovation to reduce the burden of SCD worldwide.
Collapse
Affiliation(s)
- Eloi Marijon
- Division of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France; Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France.
| | - Kumar Narayanan
- Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France; Medicover Hospitals, Hyderabad, India
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Silverchain Group, Melbourne, VIC, Australia
| | - Sérgio Barra
- Department of Cardiology, Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal
| | - Cristina Basso
- Cardiovascular Pathology Unit-Azienda Ospedaliera and Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marieke T Blom
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Lia Crotti
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Cardiomyopathy Unit and Laboratory of Cardiovascular Genetics, Department of Cardiology, Milan, Italy
| | - Andre D'Avila
- Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Cardiology, Hospital SOS Cardio, Santa Catarina, Brazil
| | - Rajat Deo
- Department of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Florence Dumas
- Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France; Emergency Department, Cochin Hospital, Paris, France
| | - Anastase Dzudie
- Cardiology and Cardiac Arrhythmia Unit, Department of Internal Medicine, DoualaGeneral Hospital, Douala, Cameroon; Yaounde Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Audrey Farrugia
- Hôpitaux Universitaires de Strasbourg, France, Strasbourg, France
| | - Kaitlyn Greeley
- Division of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France; Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France
| | | | - Wei Hua
- Cardiac Arrhythmia Center, FuWai Hospital, Beijing, China
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research and UNSW Sydney, Sydney, NSW, Australia
| | - Taku Iwami
- Kyoto University Health Service, Kyoto, Japan
| | - Juhani Junttila
- MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Rudolph W Koster
- Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Theresa M Olasveengen
- Department of Anesthesia and Intensive Care Medicine, Oslo University Hospital and Institute of Clinical Medicine, Oslo, Norway
| | - Marcus E H Ong
- Singapore General Hospital, Duke-NUS Medical School, Singapore
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George's University of London, London, UK
| | | | - Sang Do Shin
- Department of Emergency Medicine at the Seoul National University College of Medicine, Seoul, South Korea
| | - Hung-Fat Tse
- University of Hong Kong, School of Clinical Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region, China; Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zian Tseng
- Division of Cardiology, UCSF Health, University of California, San Francisco Medical Center, San Francisco, California
| | - Christian Van Der Werf
- University of Amsterdam, Heart Center, Amsterdam, Netherlands; Department of Clinical and Experimental Cardiology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christine M Albert
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bo Gregers Winkel
- Department of Cardiology, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
4
|
Fordyce CB, Kramer AH, Ainsworth C, Christenson J, Hunter G, Kromm J, Lopez Soto C, Scales DC, Sekhon M, van Diepen S, Dragoi L, Josephson C, Kutsogiannis J, Le May MR, Overgaard CB, Savard M, Schnell G, Wong GC, Belley-Côté E, Fantaneanu TA, Granger CB, Luk A, Mathew R, McCredie V, Murphy L, Teitelbaum J. Neuroprognostication in the Post Cardiac Arrest Patient: A Canadian Cardiovascular Society Position Statement. Can J Cardiol 2023; 39:366-380. [PMID: 37028905 DOI: 10.1016/j.cjca.2022.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 04/08/2023] Open
Abstract
Cardiac arrest (CA) is associated with a low rate of survival with favourable neurologic recovery. The most common mechanism of death after successful resuscitation from CA is withdrawal of life-sustaining measures on the basis of perceived poor neurologic prognosis due to underlying hypoxic-ischemic brain injury. Neuroprognostication is an important component of the care pathway for CA patients admitted to hospital but is complex, challenging, and often guided by limited evidence. Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to evaluate the evidence underlying factors or diagnostic modalities available to determine prognosis, recommendations were generated in the following domains: (1) circumstances immediately after CA; (2) focused neurologic exam; (3) myoclonus and seizures; (4) serum biomarkers; (5) neuroimaging; (6) neurophysiologic testing; and (7) multimodal neuroprognostication. This position statement aims to serve as a practical guide to enhance in-hospital care of CA patients and emphasizes the adoption of a systematic, multimodal approach to neuroprognostication. It also highlights evidence gaps.
Collapse
Affiliation(s)
- Christopher B Fordyce
- Division of Cardiology, Department of Medicine, Vancouver General Hospital, and the Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia.
| | - Andreas H Kramer
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta; Department of Critical Care, University of Calgary, Alberta
| | - Craig Ainsworth
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jim Christenson
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia
| | - Gary Hunter
- Division of Neurology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Julie Kromm
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta; Department of Critical Care, University of Calgary, Alberta
| | - Carmen Lopez Soto
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Damon C Scales
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mypinder Sekhon
- Division of Critical Care, Department of Medicine, Vancouver General Hospital, Djavad Mowafaghian Centre for Brain Health, International Centre for Repair Discoveries, University of British Columbia, Vancouver, British Columbia
| | - Sean van Diepen
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta; Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Laura Dragoi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Colin Josephson
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta; Department of Critical Care, University of Calgary, Alberta
| | - Jim Kutsogiannis
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta
| | - Michel R Le May
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Christopher B Overgaard
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Martin Savard
- Department of Neurological Sciences CHU de Québec - Hôpital de l'Enfant-Jésus Quebec City, Quebec, Canada
| | - Gregory Schnell
- Division of Cardiology, Department of Medicine, University of Calgary, Calgary, Alberta
| | - Graham C Wong
- Division of Cardiology, Department of Medicine, Vancouver General Hospital, and the Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia
| | - Emilie Belley-Côté
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Tadeu A Fantaneanu
- Division of Neurology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Adriana Luk
- Division of Cardiology, Department of Medicine, University of Toronto and the Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Rebecca Mathew
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, and the Faculty of Medicine, Division of Critical Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Victoria McCredie
- Interdepartmental Division of Critical Care Medicine, University of Toronto, the Krembil Research Institute, Toronto Western Hospital, University Health Network, and Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Laurel Murphy
- Departments of Emergency Medicine and Critical Care, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeanne Teitelbaum
- Neurological Intensive Care Unit, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
5
|
An increased potential for organ donors may be found among patients with out-of-hospital cardiac arrest. Scand J Trauma Resusc Emerg Med 2022; 30:50. [PMID: 35978359 PMCID: PMC9387073 DOI: 10.1186/s13049-022-01037-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/07/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction A prehospital system where obvious futile cases may be terminated prehospitally by physicians may reduce unethical treatment of dying patients. Withholding treatment in futile cases may seem ethically sound but may keep dying patients from becoming organ donors. The objective of this study was to characterise the prehospital patients who underwent organ donation. The aim was to alert prehospital physicians to a potential for an increase in the organ donor pool by considering continued treatment even in some prehospital patients with obvious fatal lesions or illness. Methods This is a retrospective register-based study from the Region of Southern Denmark. The prehospital medical records from patients who underwent organ donation after prehospital care from 1st of January 2016–31st of December 2020 were screened for inclusion. The outcome measures were prehospital diagnosis, vital parameters, and critical interventions. Results In the five year period, one-hundred-and-fifty-one patients were entered into a donation process in the health region following prehospital care. Sixteen patients were excluded due to limitations in data availability. Of the 135 patients included, 36.3% had a stroke. 36.7% of these patients were intubated prehospitally. 15.6% had subarachnoideal haemorrhage. 66.7% of these were intubated prehospitally. 10.4% suffered from head trauma. 64.3% of these patients were intubated at the scene. In 21.5% of the patients, the prehospitally assigned tentative diagnosis was missing or included a diverse spectrum of medical and surgical emergencies. Twenty-two patients (16.3%) were resuscitated from cardiac arrest. 81.8% were intubated at the scene. Conclusion The majority of the patients who became organ donors presented prehospitally with intracranial pathology. However, 30% of the patients that later underwent an organ donation process had other prehospital diagnoses. Among these, one patient in six had out-of-hospital cardiac arrest. Termination of treatment in patients with cardiac arrest is not uncommon in physician-manned prehospital emergency medical systems. An organ donation process cannot be initiated prehospitally but can be shut down if treatment is withheld or terminated. We contend that there is a potential for enlarging the donor pool if the decision processes in out-of-hospital cardiac arrest include considerations concerning future procurement of organ donors.
Collapse
|
6
|
Evolution of Incidence, Management, and Outcomes Over Time in Sports-Related Sudden Cardiac Arrest. J Am Coll Cardiol 2022; 79:238-246. [DOI: 10.1016/j.jacc.2021.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 12/11/2022]
|
7
|
Dumas F, Cariou A. Adrénaline au cours de la réanimation de l’arrêt cardiaque. ANNALES FRANCAISES DE MEDECINE D URGENCE 2021. [DOI: 10.3166/afmu-2021-0335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
À ce jour, l’adrénaline est fortement recommandée dans le traitement de l’arrêt cardiaque. Son utilisation est bien ancrée dans les pratiques, et elle est présente dans les recommandations et les algorithmes de prise en charge depuis des décennies. Cependant, ces mêmes recommandations reposent sur un niveau de preuve faible dans cette indication. Les propriétés pharmacologiques de l’adrénaline et ses effets secondaires et indirects peuvent expliquer en partie la controverse actuelle qui anime les experts dans ce domaine. Plusieurs études cliniques récentes, majoritairement observationnelles, ont renforcé les incertitudes concernant le devenir des patients exposés à ce traitement lors d’un arrêt cardiaque, en termes de survie et d’évolution neurologique. Ces observations ont encouragé la réalisation d’essais cliniques susceptibles de clarifier le rapport bénéfice/risque de ce traitement. Un large essai randomisé a récemment évalué l’adrénaline comparée à un placebo, et a montré l’efficacité de ce médicament concernant le succès de la réanimation initiale. Toutefois, le questionnement demeure entier concernant l’effet de ce traitement sur le devenir neurologique à distance. Actuellement, plusieurs études cliniques explorent d’autres modalités d’administration afin d’optimiser au mieux son effet sur les différents critères de jugement incluant le devenir à long terme. Globalement, même si l’adrénaline permet d’améliorer la survie immédiate après un arrêt cardiaque, son rôle reste donc incertain concernant le devenir neurologique des patients à moyen et long termes. Cependant, en l’absence d’alternative et dans l’attente de données supplémentaires, ce médicament reste recommandé dans tous les protocoles de réanimation spécialisée de l’arrêt cardiaque.
Collapse
|
8
|
Abstract
PURPOSE OF REVIEW Out-of-hospital cardiac arrest (OHCA) is the most devastating and time-critical medical emergency. Survival after OHCA requires an integrated system of care, of which transport by emergency medical services is an integral component. The transport system serves to commence and ensure uninterrupted high-quality resuscitation in suitable patients who would benefit, terminate resuscitation in those that do not, provide critical interventions, as well as convey patients to the next appropriate venue of care. We review recent evidence surrounding contemporary issues in the transport of OHCA, relating to who, where, when and how to transport these patients. RECENT FINDINGS We examine the clinical and systems-related evidence behind issues including: contemporary approaches to field termination of resuscitation in patients in whom continued resuscitation and transport to hospital would be medically futile, OHCA patients and organ donation, on-scene versus intra-transport resuscitation, significance of response time, intra-transport interventions (mechanical chest compression, targeted temperature management, ECMO-facilitated cardiopulmonary resuscitation), OHCA in high-rise locations and cardiac arrest centers. We highlight gaps in current knowledge and areas of active research. SUMMARY There remains limited evidence to guide some decisions in transporting the OHCA patient. Evidence is urgently needed to elucidate the roles of cardiac arrest centers and ECPR in OHCA.
Collapse
|
9
|
Waldmann V, Karam N, Gaye B, Bougouin W, Dumas F, Sharifzadehgan A, Narayanan K, Kassim H, Beganton F, Jost D, Lamhaut L, Loeb T, Adnet F, Agostinucci JM, Deltour S, Revaux F, Ludes B, Voicu S, Megarbane B, Jabre P, Cariou A, Marijon E, Jouven X. Temporal Trends of Out-of-Hospital Cardiac Arrests Without Resuscitation Attempt by Emergency Medical Services. Circ Cardiovasc Qual Outcomes 2021; 14:e006626. [PMID: 33706541 DOI: 10.1161/circoutcomes.120.006626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Significant improvements in survival from out-of-hospital cardiac arrest (OHCA) have been reported; however, these are based only on data from OHCA in whom resuscitation is initiated by emergency medical services (EMS). We aimed to assess the characteristics and temporal trends of OHCA without resuscitation attempt by EMS. METHODS Prospective population-based study between 2011 and 2016 in the Greater Paris area (6.7 million inhabitants). All cases of OHCA were included in collaboration with EMS units, 48 different hospitals, and forensic units. RESULTS Among 15 207 OHCA (mean age 70.7±16.9 years, 61.6% male), 5486 (36.1%) had no resuscitation attempt by EMS. Factors that were independently associated with increase in likelihood of no resuscitation attempt included: age of patients (odds ratio, 1.06 per year [95% CI, 1.05-1.06], P<0.001), female sex (odds ratio, 1.21 [95% CI, 1.10-1.32], P=0.002), OHCA at home location (odds ratio, 3.38 [95%CI, 2.86-4.01], P<0.001), and absence of bystander (odds ratio, 1.94 [95% CI, 1.74-2.16], P<0.001). Overall, the annual number of OHCA increased by 9.1% (from 2923 to 3189, P=0.028). This increase was related to an increase of the annual number of OHCA without resuscitation attempt by EMS by 26.3% (from 993 to 1253, P=0.012), while the annual number of OHCA with resuscitation attempt by EMS did not significantly change (from 1930 to 1936, P=0.416). Considering only cases with resuscitation attempt, survival rate at hospital discharge increased (from 7.3% to 9.5%, P=0.02). However, when considering all OHCA, survival improvement did not reach statistical significance (from 4.8% to 5.7%, P=0.17). CONCLUSIONS We demonstrated an increase of the total number of OHCA related to an increase of the number of OHCA without resuscitation attempt by EMS. This increasing proportion of OHCA without resuscitation attempt attenuates improvement in survival rates achieved in EMS-treated patients.
Collapse
Affiliation(s)
- Victor Waldmann
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (V.W., N.K., A.S., E.M., X.J.).,Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France (V.W., N.K., B.G., W.B., F.D., A.S., K.N., H.K., F.B., A.C., E.M., X.J.).,Paris University, France (V.W., N.K., B.G., W.B., F.D., A.S., B.L., A.C., E.M., X.J.)
| | - Nicole Karam
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (V.W., N.K., A.S., E.M., X.J.).,Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France (V.W., N.K., B.G., W.B., F.D., A.S., K.N., H.K., F.B., A.C., E.M., X.J.).,Paris University, France (V.W., N.K., B.G., W.B., F.D., A.S., B.L., A.C., E.M., X.J.)
| | - Bamba Gaye
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France (V.W., N.K., B.G., W.B., F.D., A.S., K.N., H.K., F.B., A.C., E.M., X.J.).,Paris University, France (V.W., N.K., B.G., W.B., F.D., A.S., B.L., A.C., E.M., X.J.)
| | - Wulfran Bougouin
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France (V.W., N.K., B.G., W.B., F.D., A.S., K.N., H.K., F.B., A.C., E.M., X.J.).,Paris University, France (V.W., N.K., B.G., W.B., F.D., A.S., B.L., A.C., E.M., X.J.).,Ramsay Générale de Santé, Hôpital privé Jacques Cartier, Intensive Care Unit, Massy, France (W.B.)
| | - Florence Dumas
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France (V.W., N.K., B.G., W.B., F.D., A.S., K.N., H.K., F.B., A.C., E.M., X.J.).,Paris University, France (V.W., N.K., B.G., W.B., F.D., A.S., B.L., A.C., E.M., X.J.).,Emergency Department, Cochin Hospital, Paris, France (F.D.)
| | - Ardalan Sharifzadehgan
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (V.W., N.K., A.S., E.M., X.J.).,Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France (V.W., N.K., B.G., W.B., F.D., A.S., K.N., H.K., F.B., A.C., E.M., X.J.).,Paris University, France (V.W., N.K., B.G., W.B., F.D., A.S., B.L., A.C., E.M., X.J.)
| | - Kumar Narayanan
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France (V.W., N.K., B.G., W.B., F.D., A.S., K.N., H.K., F.B., A.C., E.M., X.J.).,Cardiology Department, Medicover Hospitals, Hyderabad, India (K.N.)
| | - Haoiinda Kassim
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France (V.W., N.K., B.G., W.B., F.D., A.S., K.N., H.K., F.B., A.C., E.M., X.J.)
| | - Frankie Beganton
- Ramsay Générale de Santé, Hôpital privé Jacques Cartier, Intensive Care Unit, Massy, France (W.B.)
| | | | | | | | | | | | - Sandrine Deltour
- Cerebrovascular Unit, La Pitié Salpêtrière Hospital, Paris, France (S.D.)
| | | | - Bertrand Ludes
- Paris University, France (V.W., N.K., B.G., W.B., F.D., A.S., B.L., A.C., E.M., X.J.).,Cerebrovascular Unit, La Pitié Salpêtrière Hospital, Paris, France (S.D.)
| | - Sebastian Voicu
- Intensive Care Unit, Lariboisière Hospital, Paris, France (S.V., B.M.)
| | - Bruno Megarbane
- Intensive Care Unit, Lariboisière Hospital, Paris, France (S.V., B.M.)
| | | | - Alain Cariou
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France (V.W., N.K., B.G., W.B., F.D., A.S., K.N., H.K., F.B., A.C., E.M., X.J.).,Paris University, France (V.W., N.K., B.G., W.B., F.D., A.S., B.L., A.C., E.M., X.J.).,Intensive Care Unit, Cochin Hospital, Paris, France (A.C.)
| | - Eloi Marijon
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (V.W., N.K., A.S., E.M., X.J.).,Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France (V.W., N.K., B.G., W.B., F.D., A.S., K.N., H.K., F.B., A.C., E.M., X.J.).,Paris University, France (V.W., N.K., B.G., W.B., F.D., A.S., B.L., A.C., E.M., X.J.)
| | - Xavier Jouven
- European Georges Pompidou Hospital, Cardiology Department, Paris, France (V.W., N.K., A.S., E.M., X.J.).,Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France (V.W., N.K., B.G., W.B., F.D., A.S., K.N., H.K., F.B., A.C., E.M., X.J.).,Paris University, France (V.W., N.K., B.G., W.B., F.D., A.S., B.L., A.C., E.M., X.J.)
| | | |
Collapse
|
10
|
Glober NK, Lardaro T, Christopher S, Tainter CR, Weinstein E, Kim D. Validation of the NUE Rule to Predict Futile Resuscitation of Out-of-Hospital Cardiac Arrest. PREHOSP EMERG CARE 2020; 25:706-711. [PMID: 33026273 DOI: 10.1080/10903127.2020.1831666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM We validated the NUE rule, using three criteria (Non-shockable initial rhythm, Unwitnessed arrest, Eighty years or older) to predict futile resuscitation of patients with out-of-hospital cardiac arrest (OHCA). METHODS We performed a retrospective cohort analysis of all recorded OHCA in Marion County, Indiana, from January 1, 2014 to December 31, 2019. We described patient, arrest, and emergency medical services (EMS) response characteristics, and assessed the performance of the NUE rule in identifying patients unlikely to survive to hospital discharge. RESULTS From 2014 to 2019, EMS responded to 4370 patients who sustained OHCA. We excluded 329 (7.5%) patients with incomplete data. Median patient age was 62 years (IQR 49 - 73), 1599 (39.6%) patients were female, and 1728 (42.8%) arrests were witnessed. The NUE rule identified 290 (7.2%) arrests, of whom none survived to hospital discharge. CONCLUSION In external validation, the NUE rule (Non-shockable initial rhythm, Unwitnessed arrest, Eighty years or older) correctly identified 7.2% of OHCA patients unlikely to survive to hospital discharge. The NUE rule could be used in EMS protocols and policies to identify OHCA patients very unlikely to benefit from aggressive resuscitation.
Collapse
|
11
|
Bougouin W, Cariou A, Jouven X. Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: do not neglect potential for organ donation! Eur Heart J 2020; 41:3588. [PMID: 32860055 DOI: 10.1093/eurheartj/ehaa626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Wulfran Bougouin
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 Rue Leblanc, 75015 Paris, France.,ntensive Care Unit, Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, 6 Avenue du Noyer Lambert, 91300 Massy, France.,Paris Sudden Death Expertise Center, 56 Rue Leblanc, 75015 Paris, France
| | - Alain Cariou
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 Rue Leblanc, 75015 Paris, France.,Paris Sudden Death Expertise Center, 56 Rue Leblanc, 75015 Paris, France.,Université Paris Descartes-Sorbonne Paris Cité, Paris, France.,Medical Intensive Care Unit, APHP, Cochin Hospital, 27 rue du Faubourg Saint Jacques, 75014 Paris, France
| | - Xavier Jouven
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 Rue Leblanc, 75015 Paris, France.,Paris Sudden Death Expertise Center, 56 Rue Leblanc, 75015 Paris, France.,Université Paris Descartes-Sorbonne Paris Cité, Paris, France.,Cardiology Department, Georges Pompidou European Hospital, APHP, 20 rue Leblanc, 75015 Paris, France
| |
Collapse
|
12
|
Coll E, Miñambres E, Sánchez-Fructuoso A, Fondevila C, Campo-Cañaveral de la Cruz JL, Domínguez-Gil B. Uncontrolled Donation After Circulatory Death: A Unique Opportunity. Transplantation 2020; 104:1542-1552. [PMID: 32732830 DOI: 10.1097/tp.0000000000003139] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Uncontrolled donation after circulatory death (uDCD) refers to donation from persons who die following an unexpected and unsuccessfully resuscitated cardiac arrest. Despite the large potential for uDCD, programs of this kind only exist in a reduced number of countries with a limited activity. Barriers to uDCD are of a logistical and ethical-legal nature, as well as arising from the lack of confidence in the results of transplants from uDCD donors. The procedure needs to be designed to reduce and limit the impact of the prolonged warm ischemia inherent to the uDCD process, and to deal with the ethical issues that this practice poses: termination of advanced cardiopulmonary resuscitation, extension of advanced cardiopulmonary resuscitation beyond futility for organ preservation, moment to approach families to discuss donation opportunities, criteria for the determination of death, or the use of normothermic regional perfusion for the in situ preservation of organs. Although the incidence of primary nonfunction and delayed graft function is higher with organs obtained from uDCD donors, overall patient and graft survival is acceptable in kidney, liver, and lung transplantation, with a proper selection and management of both donors and recipients. Normothermic regional perfusion has shown to be critical to achieve optimal outcomes in uDCD kidney and liver transplantation. However, the role of ex situ preservation with machine perfusion is still to be elucidated. uDCD is a unique opportunity to improve patient access to transplantation therapies and to offer more patients the chance to donate organs after death, if this is consistent with their wishes and values.
Collapse
Affiliation(s)
| | - Eduardo Miñambres
- Intensive Care Unit and Donor Coordination Unit, Hospital Universitario Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Ana Sánchez-Fructuoso
- Nephrology Department, Hospital Universitario Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | | | | | | |
Collapse
|
13
|
Jentzer JC, Herrmann J, Prasad A, Barsness GW, Bell MR. Utility and Challenges of an Early Invasive Strategy in Patients Resuscitated From Out-of-Hospital Cardiac Arrest. JACC Cardiovasc Interv 2020; 12:697-708. [PMID: 31000007 DOI: 10.1016/j.jcin.2019.01.245] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/09/2019] [Accepted: 01/15/2019] [Indexed: 12/16/2022]
Abstract
Out-of-hospital cardiac arrest (OHCA) is frequently triggered by acute myocardial ischemia. Coronary angiography is an important component of post-resuscitation care for patients with OHCA without an evident noncardiac cause, to identify underlying coronary artery disease and allow revascularization. Most patients undergoing coronary angiography after OHCA have obstructive coronary artery disease, and nearly one-half of patients have acute coronary occlusion. Early coronary angiography and percutaneous coronary intervention after OHCA have been associated with improved survival in observational studies, but these studies demonstrate selection bias, and randomized trials are lacking. Selection of patients for coronary angiography after OHCA can be challenging, particularly in comatose patients whose outcomes are driven primarily by anoxic brain injury. As for other patients with acute coronary syndromes, patients with ST-segment elevation after OHCA have a high probability of acute coronary occlusion warranting emergent coronary angiography. Patients with cardiogenic shock after OHCA are a high-risk population also requiring emergent coronary angiography. Among patients in stable condition after OHCA without ST-segment elevation, other clinical predictors can be used to identify those needing early coronary angiography to identify obstructive coronary artery disease. Despite the challenges with early neurological prognostication in comatose patients with OHCA, those with multiple objective markers of poor prognosis appear less likely to benefit from revascularization, and early coronary angiography may be reasonably deferred in appropriately selected patients meeting these criteria. The authors propose an algorithm to guide patient selection for coronary angiography after OHCA that combines clinical predictors of acute coronary occlusion and early clinical predictors of severe brain injury.
Collapse
Affiliation(s)
- Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Joerg Herrmann
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Abhiram Prasad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Gregory W Barsness
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Malcolm R Bell
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
14
|
Marijon E, Karam N, Jost D, Perrot D, Frattini B, Derkenne C, Sharifzadehgan A, Waldmann V, Beganton F, Narayanan K, Lafont A, Bougouin W, Jouven X. Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study. LANCET PUBLIC HEALTH 2020; 5:e437-e443. [PMID: 32473113 PMCID: PMC7255168 DOI: 10.1016/s2468-2667(20)30117-1] [Citation(s) in RCA: 343] [Impact Index Per Article: 85.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/04/2020] [Accepted: 05/11/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although mortality due to COVID-19 is, for the most part, robustly tracked, its indirect effect at the population level through lockdown, lifestyle changes, and reorganisation of health-care systems has not been evaluated. We aimed to assess the incidence and outcomes of out-of-hospital cardiac arrest (OHCA) in an urban region during the pandemic, compared with non-pandemic periods. METHODS We did a population-based, observational study using data for non-traumatic OHCA (N=30 768), systematically collected since May 15, 2011, in Paris and its suburbs, France, using the Paris Fire Brigade database, together with in-hospital data. We evaluated OHCA incidence and outcomes over a 6-week period during the pandemic in adult inhabitants of the study area. FINDINGS Comparing the 521 OHCAs of the pandemic period (March 16 to April 26, 2020) to the mean of the 3052 total of the same weeks in the non-pandemic period (weeks 12-17, 2012-19), the maximum weekly OHCA incidence increased from 13·42 (95% CI 12·77-14·07) to 26·64 (25·72-27·53) per million inhabitants (p<0·0001), before returning to normal in the final weeks of the pandemic period. Although patient demographics did not change substantially during the pandemic compared with the non-pandemic period (mean age 69·7 years [SD 17] vs 68·5 [18], 334 males [64·4%] vs 1826 [59·9%]), there was a higher rate of OHCA at home (460 [90·2%] vs 2336 [76·8%]; p<0·0001), less bystander cardiopulmonary resuscitation (239 [47·8%] vs 1165 [63·9%]; p<0·0001) and shockable rhythm (46 [9·2%] vs 472 [19·1%]; p<0·0001), and longer delays to intervention (median 10·4 min [IQR 8·4-13·8] vs 9·4 min [7·9-12·6]; p<0·0001). The proportion of patients who had an OHCA and were admitted alive decreased from 22·8% to 12·8% (p<0·0001) in the pandemic period. After adjustment for potential confounders, the pandemic period remained significantly associated with lower survival rate at hospital admission (odds ratio 0·36, 95% CI 0·24-0·52; p<0·0001). COVID-19 infection, confirmed or suspected, accounted for approximately a third of the increase in OHCA incidence during the pandemic. INTERPRETATION A transient two-times increase in OHCA incidence, coupled with a reduction in survival, was observed during the specified time period of the pandemic when compared with the equivalent time period in previous years with no pandemic. Although this result might be partly related to COVID-19 infections, indirect effects associated with lockdown and adjustment of health-care services to the pandemic are probable. Therefore, these factors should be taken into account when considering mortality data and public health strategies. FUNDING The French National Institute of Health and Medical Research (INSERM).
Collapse
Affiliation(s)
- Eloi Marijon
- Université de Paris, Centre de Recherche Cardiovasculaire de Paris, INSERM, Paris, France; Paris-Sudden Death Expertise Center, Paris, France; European Georges Pompidou Hospital, Cardiology Department, Paris, France.
| | - Nicole Karam
- Université de Paris, Centre de Recherche Cardiovasculaire de Paris, INSERM, Paris, France; Paris-Sudden Death Expertise Center, Paris, France; European Georges Pompidou Hospital, Cardiology Department, Paris, France
| | - Daniel Jost
- Paris-Sudden Death Expertise Center, Paris, France; Paris Fire Brigade, Paris, France
| | - David Perrot
- Université de Paris, Centre de Recherche Cardiovasculaire de Paris, INSERM, Paris, France; Paris-Sudden Death Expertise Center, Paris, France
| | | | | | - Ardalan Sharifzadehgan
- Université de Paris, Centre de Recherche Cardiovasculaire de Paris, INSERM, Paris, France; Paris-Sudden Death Expertise Center, Paris, France; European Georges Pompidou Hospital, Cardiology Department, Paris, France
| | - Victor Waldmann
- Université de Paris, Centre de Recherche Cardiovasculaire de Paris, INSERM, Paris, France; Paris-Sudden Death Expertise Center, Paris, France; European Georges Pompidou Hospital, Cardiology Department, Paris, France
| | - Frankie Beganton
- Université de Paris, Centre de Recherche Cardiovasculaire de Paris, INSERM, Paris, France; Paris-Sudden Death Expertise Center, Paris, France
| | | | - Antoine Lafont
- Université de Paris, Centre de Recherche Cardiovasculaire de Paris, INSERM, Paris, France; Paris-Sudden Death Expertise Center, Paris, France; European Georges Pompidou Hospital, Cardiology Department, Paris, France
| | - Wulfran Bougouin
- Université de Paris, Centre de Recherche Cardiovasculaire de Paris, INSERM, Paris, France; Paris-Sudden Death Expertise Center, Paris, France; Jacques Cartier Hospital, Intensive Care Unit, Massy, France
| | - Xavier Jouven
- Université de Paris, Centre de Recherche Cardiovasculaire de Paris, INSERM, Paris, France; Paris-Sudden Death Expertise Center, Paris, France; European Georges Pompidou Hospital, Cardiology Department, Paris, France
| |
Collapse
|
15
|
Kidney transplantation following uncontrolled donation after circulatory death. Curr Opin Organ Transplant 2020; 25:144-150. [DOI: 10.1097/mot.0000000000000742] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
16
|
Waldmann V, Karam N, Rischard J, Bougouin W, Sharifzadehgan A, Dumas F, Narayanan K, Sideris G, Voicu S, Gandjbakhch E, Jost D, Lamhaut L, Ludes B, Plu I, Beganton F, Wahbi K, Varenne O, Megarbane B, Algalarrondo V, Extramiana F, Lellouche N, Celermajer DS, Spaulding C, Lafont A, Cariou A, Jouven X, Marijon E. Low rates of immediate coronary angiography among young adults resuscitated from sudden cardiac arrest. Resuscitation 2020; 147:34-42. [PMID: 31857140 DOI: 10.1016/j.resuscitation.2019.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 11/29/2019] [Accepted: 12/04/2019] [Indexed: 11/27/2022]
Abstract
AIM Coronary artery disease (CAD) has recently been emphasized as a major cause of sudden cardiac arrest (SCA) in young adults. We aim to assess the rate of immediate coronary angiography performance in young patients resuscitated from SCA. METHODS From May 2011 to May 2017, all cases of out-of-hospital SCA aged 18-40 years alive at hospital admission were prospectively included in 48 hospitals of the Great Paris area. Cardiovascular causes of SCA were centrally adjudicated, and management including immediate coronary angiography performance was assessed. RESULTS Out of 3579 SCA admitted alive, 409 (11.4%) patients were under 40 years of age (32.3 ± 6.2 years, 69.7% males), with 244 patients having a definite cause identified. Among those, CAD accounted for 72 (29.5%) cases, of which 64 (88.9%) were acute coronary syndromes. The rate of immediate coronary angiography was only 41.7% compared to 65.1% among those ≥40-years (P < 0.001). During the study period, while the rate of immediate coronary angiography increased from 60.5% to 70.3% (P < 0.001) in patients aged ≥40 years, the rate in patients aged less than 40 years remained stable (43.5% to 45.3%, P = 0.795). Patients younger than 40 years were significantly less likely to undergo immediate coronary angiography (OR = 0.34, 95% CI: 0.25-0.47), although early angiography was associated with survival at hospital discharge (OR = 2.68, 95% CI: 1.21-6.00). CONCLUSION CAD is the first cause of SCA in young adults aged less than 40 years. The observed low rates of immediate coronary angiography suggest a missed opportunity for early intervention.
Collapse
Affiliation(s)
- Victor Waldmann
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France
| | - Nicole Karam
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France
| | - Julien Rischard
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
| | - Wulfran Bougouin
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France; Ramsay Générale de Santé, Hôpital privé Jacques Cartier, Intensive Care Unit, Massy, France
| | - Ardalan Sharifzadehgan
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France
| | - Florence Dumas
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France; AP-HP, Cochin-Hotel Hospital, Emergency Department, Paris, France
| | - Kumar Narayanan
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Medicover Hospitals, Hyderabad, India
| | - Georgios Sideris
- AP-HP, Lariboisière Hospital, Cardiology Department, Paris, France
| | - Sebastian Voicu
- AP-HP, Lariboisière Hospital, Intensive Care Unit, Paris, France
| | - Estelle Gandjbakhch
- AP-HP, La Pitié Salpêtrière University Hospital, Cardiology Department, Paris, France; Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), France
| | | | | | | | - Isabelle Plu
- AP-HP, La Pitié Salpêtrière University Hospital, Anatomopathology Department, Paris, France
| | - Frankie Beganton
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
| | - Karim Wahbi
- Paris University, Paris, France; AP-HP, Cochin Hospital, Cardiology Department, Paris, France
| | - Olivier Varenne
- Paris University, Paris, France; AP-HP, Cochin Hospital, Cardiology Department, Paris, France
| | - Bruno Megarbane
- AP-HP, Lariboisière Hospital, Intensive Care Unit, Paris, France
| | - Vincent Algalarrondo
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), France; AP-HP, Bichat-Claude-Bernard Hospital, Cardiology Department, Paris, France
| | - Fabrice Extramiana
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), France; AP-HP, Bichat-Claude-Bernard Hospital, Cardiology Department, Paris, France
| | - Nicolas Lellouche
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), France; AP-HP, Henri Mondor Hospital, Cardiology Department, Créteil, France
| | | | - Christian Spaulding
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris University, Paris, France
| | - Antoine Lafont
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris University, Paris, France
| | - Alain Cariou
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France; AP-HP, Cochin Hospital, Intensive Care Unit, Paris, France
| | - Xavier Jouven
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France
| | - Eloi Marijon
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France; Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), France.
| | | |
Collapse
|
17
|
Identifying out-of-hospital cardiac arrest patients with no chance of survival: An independent validation of prediction rules. Resuscitation 2019; 146:19-25. [PMID: 31711916 DOI: 10.1016/j.resuscitation.2019.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 10/29/2019] [Accepted: 11/01/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Basic life support (BLS) and Advanced life support (ALS) are known prediction rules for termination of resuscitation (TOR) in out-of-hospital cardiac arrest (OHCA). Recently, a new rule was developed by Jabre et al. We aimed to independently validate and compare the predictive accuracy of these rules. METHODS OHCA cases in Iceland from 2008 to 2017 from a population-based, prospectively registered database. Primary outcome was survival to discharge among patients that met all conditions of abovementioned rules: BLS (not witnessed by EMS personnel, no defibrillation nor ROSC before transport), ALS (BLS criteria plus not witnessed nor CPR by bystander) and Jabre (not witnessed by EMS personnel, initial rhythm non-shockable, no sustainable ROSC before third dose of adrenaline). RESULTS Overall, 568 OHCA patients were included in validation of TOR rules. Mean age 67, males 74%, witnessed by EMS 11%, by bystander 66% that attempted CPR in 50%, transported to hospital 60%, overall survival 20%. All rules had high specificity for mortality, 99.6-100% (95%CI 95-100). The Jabre and BLS rules had similar sensitivity 47% (43-52) vs. 44% (40-49), respectively, the sensitivity of ALS was lower, 8% (5-11). Combined use of positive BLS and Jabre rules performed the best, identifying 88/226 (39%) of futile cases transported to hospital, specificity 100% (97-100) and sensitivity 59% (55-64). CONCLUSIONS The accuracy of the BLS and Jabre TOR rules to predict mortality after OHCA is very good and their combined use may be superior to the use of either one.
Collapse
|
18
|
Organ donation after resuscitation from cardiac arrest. Resuscitation 2019; 145:63-69. [PMID: 31654724 DOI: 10.1016/j.resuscitation.2019.10.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/27/2019] [Accepted: 10/14/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND We compared the characteristics and outcomes of post-arrest donors to those of other donors, described the proportion of post-arrest decedents who donated, and compared their characteristics to post-arrest decedents who did not donate. METHODS We performed a retrospective cohort study including patients who died at a single academic medical center from January 1, 2010 to February 28, 2019. We linked our registry of consecutive post-arrest patients to donation-related data from the Center for Organ Procurement and Recovery (CORE). We used data from CORE to identify donor eligibility, first person designation, family approaches to seek consent for donation, and approach outcomes. We determined number of organs procured and number transplanted, stratified by donor type (brain death donors (BDD) vs donors after circulatory determination of death (DCD)). RESULTS There were 12,130 decedents; 1525 (13%) were resuscitated from cardiac arrest. CORE staff approached families of 836 (260 (31%) post-arrest, 576 (69%) not post-arrest) to request donation. Post-arrest patients and families were more likely to authorize donation (172/260 (66%) vs 331/576 (57%), P = 0.02), and more likely to be DCDs (50/146 (34%) vs 55/289 (19%), P < 0.001). Overall, 4.1 ± 1.5 organs were procured and 2.9 ± 1.9 transplanted per BDD, which did not differ by post-arrest status, 3.2 ± 1.2 organs were procured and 1.8 ± 1.1 transplanted per DCD. Number of organs transplanted per DCD did not differ by post-arrest status. Unfavorable arrest characteristics were more common among post-arrest organ donors compared to non-donors. CONCLUSION Patients resuscitated from cardiac arrest with irrecoverable brain injury have excellent potential to become organ donors.
Collapse
|
19
|
Javaudin F, Le Bastard Q, Lascarrou JB, Baert V, Hubert H. The futility of resuscitating an out-of-hospital cardiac arrest cannot be summarized by three simple criteria. Resuscitation 2019; 144:199-200. [PMID: 31539611 DOI: 10.1016/j.resuscitation.2019.08.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
Affiliation(s)
- François Javaudin
- Department of Emergency Medicine, University Hospital of Nantes, France; University of Nantes, Microbiotas Hosts Antibiotics and Bacterial Resistances (MiHAR), Nantes, France.
| | - Quentin Le Bastard
- Department of Emergency Medicine, University Hospital of Nantes, France; University of Nantes, Microbiotas Hosts Antibiotics and Bacterial Resistances (MiHAR), Nantes, France
| | | | - Valentine Baert
- Public Health Department EA 2694, University of Lille, Lille University Hospital, France
| | - Hervé Hubert
- Public Health Department EA 2694, University of Lille, Lille University Hospital, France
| | -
- Public Health Department EA 2694, University of Lille, Lille University Hospital, France
| | -
- Public Health Department EA 2694, University of Lille, Lille University Hospital, France
| |
Collapse
|
20
|
Eshcol JO, Chhatriwalla AK. Selective Coronary Angiography Following Cardiac Arrest. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2019. [DOI: 10.15212/cvia.2017.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
21
|
Pechmajou L, Sharifzadehgan A, Bougouin W, Dumas F, Beganton F, Jost D, Lamhaut L, Lecarpentier E, Loeb T, Adnet F, Agostinucci JM, Narayanan K, Sideris G, Voicu S, Cariou A, Spaulding C, Marijon E, Jouven X, Karam N. Does occurrence during sports affect sudden cardiac arrest survival? Resuscitation 2019; 141:121-127. [PMID: 31238153 DOI: 10.1016/j.resuscitation.2019.06.277] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/30/2019] [Accepted: 06/16/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES A higher survival rate was observed in Sudden Cardiac Arrest (SCA) occurring during sports activities, although the underlying mechanisms remain unclear. We tested the hypothesis that better initial management, rather than sports per se, may account for the observed better outcomes during sports activities. METHODS Data was taken between May 2011 and March 2016 from a prospective ongoing registry that includes all SCA in Paris and suburbs (6.7 million inhabitants). Sports-related SCA (i.e. SCA occurring during sport activities or within one hour of cessation of the activity) were identified. RESULTS Over the study period, 13,400 SCA occurred, of which 154 were sports-related (median age: 51.2 years, 96.1% males). At discharge, sports activity was associated with an 8-times higher survival rate (39.7% vs. 5.1%, P < 0.001). Logistic regression showed that after considering potential confounders, including age, gender, SCA location, witness presence, time to response, and initial shockable rhythm, occurrence of SCA during sports was associated with a higher survival rate (OR 1.77, 95% CI 1.14-2.74, P = 0.01). However, after further adjustment for initial basic life support, i.e. bystander CPR and AED use, there was no association between sports setting and survival at hospital discharge (OR 1.43, 95% CI 0.91-2.23, P = 0.12). CONCLUSION Sports-related SCA is a rare event, with an 8-times higher survival rate compared to non-sports-related SCA. Better initial management, including bystander CPR and AED use, rather than sports per se, mainly accounts this difference. This highlights the major importance of population education to basic life support in improving SCA outcome.
Collapse
Affiliation(s)
- Louis Pechmajou
- Paris-Sudden Death Expertise Center (Paris-SDEC), INSERM Unit 970, Paris Cardiovascular Research Center, Paris, France; Paris Descartes University, Paris, France; Cardiology Department, European Hospital Georges Pompidou, Paris, France
| | - Ardalan Sharifzadehgan
- Paris-Sudden Death Expertise Center (Paris-SDEC), INSERM Unit 970, Paris Cardiovascular Research Center, Paris, France; Paris Descartes University, Paris, France; Cardiology Department, European Hospital Georges Pompidou, Paris, France
| | - Wulfran Bougouin
- Paris-Sudden Death Expertise Center (Paris-SDEC), INSERM Unit 970, Paris Cardiovascular Research Center, Paris, France; Paris Descartes University, Paris, France
| | - Florence Dumas
- Paris-Sudden Death Expertise Center (Paris-SDEC), INSERM Unit 970, Paris Cardiovascular Research Center, Paris, France; Paris Descartes University, Paris, France; Emergency Department, Cochin Hospital, Paris, France
| | - Frankie Beganton
- Paris-Sudden Death Expertise Center (Paris-SDEC), INSERM Unit 970, Paris Cardiovascular Research Center, Paris, France
| | - Daniel Jost
- Paris-Sudden Death Expertise Center (Paris-SDEC), INSERM Unit 970, Paris Cardiovascular Research Center, Paris, France; Paris Firefighters Brigade, Paris, France
| | - Lionel Lamhaut
- Paris-Sudden Death Expertise Center (Paris-SDEC), INSERM Unit 970, Paris Cardiovascular Research Center, Paris, France; Paris Descartes University, Paris, France; Emergency Medical Services (SAMU) 75, Necker Hospital, Paris, France
| | - Eric Lecarpentier
- Emergency Medical Services (SAMU) 94, Henri Mondor Hospital, Creteil, France
| | - Thomas Loeb
- Emergency Medical Services (SAMU) 92, Raymond Poincaré Hospital, Garches, France
| | - Frédéric Adnet
- Emergency Medical Services (SAMU) 93, Avicenne Hospital, Bobigny, France
| | | | - Kumar Narayanan
- Paris-Sudden Death Expertise Center (Paris-SDEC), INSERM Unit 970, Paris Cardiovascular Research Center, Paris, France; Cardiology Department, Maxcure Hospital, Hyderabad, India
| | | | | | - Alain Cariou
- Paris-Sudden Death Expertise Center (Paris-SDEC), INSERM Unit 970, Paris Cardiovascular Research Center, Paris, France; Paris Descartes University, Paris, France; Intensive Care Unit, Cochin Hospital, Paris, France
| | - Christian Spaulding
- Paris-Sudden Death Expertise Center (Paris-SDEC), INSERM Unit 970, Paris Cardiovascular Research Center, Paris, France; Paris Descartes University, Paris, France; Cardiology Department, European Hospital Georges Pompidou, Paris, France
| | - Eloi Marijon
- Paris-Sudden Death Expertise Center (Paris-SDEC), INSERM Unit 970, Paris Cardiovascular Research Center, Paris, France; Paris Descartes University, Paris, France; Cardiology Department, European Hospital Georges Pompidou, Paris, France
| | - Xavier Jouven
- Paris-Sudden Death Expertise Center (Paris-SDEC), INSERM Unit 970, Paris Cardiovascular Research Center, Paris, France; Paris Descartes University, Paris, France; Cardiology Department, European Hospital Georges Pompidou, Paris, France
| | - Nicole Karam
- Paris-Sudden Death Expertise Center (Paris-SDEC), INSERM Unit 970, Paris Cardiovascular Research Center, Paris, France; Paris Descartes University, Paris, France; Cardiology Department, European Hospital Georges Pompidou, Paris, France.
| | | |
Collapse
|
22
|
Controlling the uncontrolled: Can we realise the potential of uncontrolled donation after circulatory death? Resuscitation 2019; 137:234-236. [DOI: 10.1016/j.resuscitation.2019.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 12/29/2022]
|
23
|
Organ donation after circulatory death: current status and future potential. Intensive Care Med 2019; 45:310-321. [DOI: 10.1007/s00134-019-05533-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/14/2019] [Indexed: 01/26/2023]
|
24
|
Adt C, Salignon J, Freund Y, Espinasse E, Ray P, Avondo A. Influence de l’âge sur les durées de réanimation des arrêts cardiaques préhospitaliers. ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2018-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction : L’objectif de notre étude est de déterminer si l’âge des patients en arrêt cardiaque (AC) a une influence sur les durées de réanimation cardiopulmonaire (RCP) par les équipes préhospitalières.
Patients et méthodes : Nous avons réalisé une étude monocentrique, prospective, à partir des données de notre centre hospitalier universitaire, issues du Registre électronique des arrêts cardiaques. Ont été inclus tous les patients ayant présenté un AC, hormis ceux retrouvés en état de rigidité cadavérique ou qui avaient préalablement exprimé des directives anticipées sur leur fin de vie. Les patients ont été séparés en deux groupes selon leur âge : les moins de 75 ans et ceux de 75 ans et plus. Le critère de jugement principal était la durée de RCP spécialisée décidée par le médecin de l’équipe préhospitalière.
Résultats : Du 1er janvier au 31 décembre 2015, sur 253 patients victimes d’AC, 188 (74 % d’hommes, 78 % d’asystolie) ont bénéficié d’une RCP par une équipe du Service mobile d’urgence et de réanimation. Il y a eu 39 % de récupération d’une activité cardiaque spontanée (RACS). Seuls 31 % des patients étaient admis vivants à l’hôpital, ils étaient 6 % à j30. La durée de RCP était plus importante pour les patients de moins de 75 ans (29 ± 15 vs 23 ± 19 minutes ; p < 0,01). Mais pour les patients ayant une RACS, la durée de RCP était identique entre les deux groupes (16 ± 10 vs 14 ± 9 minutes ; p = 0,34). La survie des patients de 75 ans et plus était de 10 vs 22 % pour les moins de 75 ans (p = 0,35).
Conclusion : Notre étude suggère que l’âge des patients influence négativement les durées de réanimation des équipes préhospitalières.
Collapse
|
25
|
Del Río F, Andrés A, Padilla M, Sánchez-Fructuoso AI, Molina M, Ruiz Á, Pérez-Villares JM, Peiró LZ, Aldabó T, Sebastián R, Miñambres E, Pita L, Casares M, Galán J, Vidal C, Terrón C, Castro P, Sanroma M, Coll E, Domínguez-Gil B. Kidney transplantation from donors after uncontrolled circulatory death: the Spanish experience. Kidney Int 2018; 95:420-428. [PMID: 30579725 DOI: 10.1016/j.kint.2018.09.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/04/2018] [Accepted: 09/06/2018] [Indexed: 10/27/2022]
Abstract
Donation after uncontrolled circulatory death (uDCD) refers to donation from persons who have died following cardiac arrest and unsuccessful attempt at resuscitation. We report the Spanish experience of uDCD kidney transplantation, and identify factors related to short-term post-transplant outcomes. The Spanish CORE system compiles data on all donation and transplant procedures in the country. Between 2012-2015, 517 kidney transplants from 288 uDCD donors were performed. The incidence of primary non-function was 10%, and the incidence of delayed graft function was 76%. One-year death-censored graft survival was 87%. In a Cox-Model, donor age ≥ 60 years (odds ratio [OR] 2.7; 95% confidence interval [CI] 1.2-6.1), in situ cooling of kidneys versus normothermic regional perfusion (OR 5.6; 95% CI 2.7-11.5) or hypothermic regional perfusion based on the use of extracorporeal membrane oxygenation devices (OR 4.3; 95% CI 2.1-8.6), and a recipient history of prior kidney transplant (OR 3.5; 95% CI 1.5-8.3) all significantly increased the risk of graft loss during the first year after transplantation. Kidney transplantation from uDCD donors provides acceptable 1-year outcomes, although there is room for improvement. Hypothermic and normothermic regional perfusion strategies are preferable to in situ cooling of kidneys from uDCD donors.
Collapse
Affiliation(s)
| | - Amado Andrés
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - María Molina
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | - Teresa Aldabó
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | - Lidia Pita
- Complejo Hospitalario Universitario A Coruña, La Coruña, Spain
| | | | - Juan Galán
- Hospital Universitario y Politécnico de la Fe, Valencia, Spain
| | | | | | - Pablo Castro
- Regional Coordination of the Autonomous Community of Andalucía, Sevilla, Spain
| | - Marga Sanroma
- Regional Coordination of the Autonomous Community of Cataluña, Barcelona, Spain
| | | | | | | |
Collapse
|
26
|
Legriel S, Bougouin W, Chocron R, Beganton F, Lamhaut L, Aissaoui N, Deye N, Jost D, Mekontso-Dessap A, Vieillard-Baron A, Marijon E, Jouven X, Dumas F, Cariou A. Early in-hospital management of cardiac arrest from neurological cause: Diagnostic pitfalls and treatment issues. Resuscitation 2018; 132:147-155. [DOI: 10.1016/j.resuscitation.2018.08.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/30/2018] [Accepted: 08/03/2018] [Indexed: 01/25/2023]
|
27
|
Aissaoui N, Bougouin W, Dumas F, Beganton F, Chocron R, Varenne O, Spaulding C, Karam N, Montalescot G, Aubry P, Sideris G, Marijon E, Jouven X, Cariou A. Age and benefit of early coronary angiography after out-of-hospital cardiac arrest in patients presenting with shockable rhythm: Insights from the Sudden Death Expertise Center registry. Resuscitation 2018; 128:126-131. [PMID: 29746987 DOI: 10.1016/j.resuscitation.2018.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 05/02/2018] [Accepted: 05/06/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Little is known about the association between provision of post-resuscitation care and prognosis of out-of-hospital cardiac arrest (OHCA) in elderly patients. Previous studies have suggested futility after 65 years of age. OBJECTIVES We aimed to evaluate the association of early coronary angiogram (CAG) followed if necessary by percutaneous coronary intervention (PCI), with favorable outcome after OHCA among elderly patients, compared to younger patients. METHODS Using a large French registry, we included all OHCA patients with an initial shockable rhythm, transported to hospital from 2011 to 2015. Favorable outcome was defined as hospital discharge with Cerebral Performance Category (CPC) 1 or 2. and were evaluated by multivariate logistic regression. Subgroup analyses were performed according to age groups: <65, 65-75 and >75 years. RESULTS Among 1502 included patients, 31% were older than 65 and 12% older than 75 years. An early CAG was performed in 79%, 88% and 76% of patients below 65, between 65 and 75 and above 75, respectively (P = 0.002). The rate of patients discharged with CPC1 or 2 was 42% below 65, 38% between 65 and 75 and 24% above 75 (P < 0.001). Among the whole population, early CAG (OR = 6.4, 95% CI = 3.9-10.5, P < 0.001) was associated with favorable outcome. In subgroups analysis, CAG was associated with favorable outcome among patients <65 and 65-75. In patients >75, there was a trend towards a favorable outcome (OR2.9, 95CI = 0.9-9.1). CONCLUSIONS In a large registry of OHCA survivors, the early CAG use was associated with a better prognosis. This benefit was persistent up to 75 years of age, suggesting that age alone should not guide the decision for early invasive strategy.
Collapse
Affiliation(s)
- Nadia Aissaoui
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou (HEGP), Department of Critical Care Unit, Paris, France; Université Paris-Descartes, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France.
| | - Wulfran Bougouin
- Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France
| | - Florence Dumas
- Université Paris-Descartes, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; APHP, Emergency Department, Cochin/Hotel-Dieu Hospital, Paris, France
| | | | - Richard Chocron
- Université Paris-Descartes, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; APHP, Emergency Department, HEGP, Paris, France
| | - Olivier Varenne
- Université Paris-Descartes, Paris, France; AP-HP, Cochin, Department of Cardiology, Paris, France
| | - Christian Spaulding
- Université Paris-Descartes, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; AP-HP, HEGP, Department of Cardiology, Paris, France
| | - Nicole Karam
- Université Paris-Descartes, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; AP-HP, HEGP, Department of Cardiology, Paris, France
| | - Gilles Montalescot
- AP-HP, Hôpital Pitié-Salpêtrière, Department of Cardiology, Paris, France; Université Pierre et Marie Curie, Paris, France
| | - Pierre Aubry
- AP-HP, Hôpital Bichat, Department of Cardiology, Paris, France; Université Paris Diderot, Paris, France
| | - Georges Sideris
- Université Paris Diderot, Paris, France; AP-HP, Hôpital Lariboisière, Department of Cardiology, Paris, France
| | - Eloi Marijon
- Université Paris-Descartes, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; AP-HP, HEGP, Department of Cardiology, Paris, France
| | - Xavier Jouven
- Université Paris-Descartes, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; AP-HP, HEGP, Department of Cardiology, Paris, France
| | - Alain Cariou
- Université Paris-Descartes, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; APHP, Hôpital Cochin, Department of Critical Care Unit, Paris, France
| | | |
Collapse
|
28
|
Should We Perform an Immediate Coronary Angiogram in All Patients After Cardiac Arrest? JACC Cardiovasc Interv 2018; 11:249-256. [DOI: 10.1016/j.jcin.2017.09.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/25/2017] [Accepted: 09/13/2017] [Indexed: 11/20/2022]
|
29
|
Navalpotro-Pascual JM, Echarri-Sucunza A, Mateos-Rodríguez A, Peinado-Vallejo F, del Valle PF, Alonso-Moreno D, del Pozo-Pérez C, Mier-Ruiz MV, Ruiz-Azpiazu JI, Bravo-Castello J, Martinez-Cuellar N, Sáez-Jiménez A, López-Unanua C, Antón-Ramas R, Escriche-López MDC, Giraldo-Sebastià JM, García-Ochoa MJ, Martín-Sánchez E, Borraz-Clares D, Del Valle MM, Carriedo-Scher C, Rosell-Ortiz F. Uncontrolled donation programs after out-of-hospital cardiac arrest. An estimation of potential donors. Resuscitation 2018; 122:87-91. [DOI: 10.1016/j.resuscitation.2017.11.059] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/21/2017] [Accepted: 11/24/2017] [Indexed: 12/11/2022]
|
30
|
Potpara TS, Mihajlovic M, Stankovic S, Jozic T, Jozic I, Asanin MR, Ahmad R, Lip GYH. External Validation of the Simple NULL-PLEASE Clinical Score in Predicting Outcome of Out-of-Hospital Cardiac Arrest. Am J Med 2017. [PMID: 28647407 DOI: 10.1016/j.amjmed.2017.05.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Rapid clinical decision-making on further management of patients with out-of-hospital cardiac arrest may be challenging. Recently, a "futility" score (NULL-PLEASE) incorporating multiple adverse resuscitation features (Nonshockable rhythm, Unwitnessed arrest, Long no-flow or Long low-flow period, blood PH <7.2, Lactate >7.0 mmol/L, End-stage chronic kidney disease on dialysis, Age ≥85 years, Still resuscitation, and Extracardiac cause) has been proposed to help identify patients with out-of-hospital cardiac arrest unlikely to survive; however, external independent score validation is lacking. METHODS We retrospectively validated the NULL-PLEASE predictive ability for early in-hospital outcome of out-of-hospital cardiac arrest in a single-center cohort of 547 consecutive patients with out-of-hospital cardiac arrest who were admitted from April 2013 to October 2016 (mean age, 66.3 ± 13.2 years); 227 patients (41.5%) died. Because pH and lactate were inconsistently measured, a modified NULL-PLEASE score excluding both variables was calculated as the principal analysis. A sensitivity analysis included the subgroup with pH data available (n = 177). RESULTS Long low-flow period and age ≥85 years were independently associated with fatal outcome (both P < .001). Patients with a modified NULL-PLEASE score of ≥5 had a 3.3-fold greater risk of fatal outcome compared with a score of 0 to 4 (odds ratio, 3.34; 95% confidence interval [CI], 2.29-4.89; P < .001); 77% of nonsurvivors had a score ≥5; NULL-PLEASE showed a modest predictive ability for fatal outcome (c-statistic 0.658; 95% CI, 0.613-0.704; P < .001). Sensitivity analysis yielded similar results, with 88% of nonsurvivors having a score ≥5. CONCLUSIONS The NULL-PLEASE score was predictive for early in-hospital outcome of out-of-hospital cardiac arrest, with a 3.3-fold greater odds for fatal outcome at the score values of ≥5.
Collapse
Affiliation(s)
- Tatjana S Potpara
- Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia; School of Medicine, Belgrade University, Belgrade, Serbia
| | | | - Sanja Stankovic
- Emergency Centre, Clinical Centre of Serbia, Belgrade, Serbia
| | - Tanja Jozic
- Emergency Centre, Clinical Centre of Serbia, Belgrade, Serbia
| | - Irena Jozic
- Emergency Centre, Clinical Centre of Serbia, Belgrade, Serbia
| | - Milika R Asanin
- School of Medicine, Belgrade University, Belgrade, Serbia; Emergency Centre, Clinical Centre of Serbia, Belgrade, Serbia
| | - Rajai Ahmad
- Cardiology Department, City Hospital, Birmingham, United Kingdom
| | - Gregory Y H Lip
- School of Medicine, Belgrade University, Belgrade, Serbia; Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom.
| |
Collapse
|
31
|
Reply to «Decisions after irreversible cardiopulmonary arrest: ends and opportunities». Med Intensiva 2017. [PMID: 28645435 DOI: 10.1016/j.medin.2017.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
32
|
Bernat JL. Declare Death or Attempt Experimental Resuscitation? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2017; 17:17-19. [PMID: 28430067 DOI: 10.1080/15265161.2017.1299249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
|
33
|
Martinell L, Nielsen N, Herlitz J, Karlsson T, Horn J, Wise MP, Undén J, Rylander C. Early predictors of poor outcome after out-of-hospital cardiac arrest. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:96. [PMID: 28410590 PMCID: PMC5391587 DOI: 10.1186/s13054-017-1677-2] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 03/22/2017] [Indexed: 12/24/2022]
Abstract
Background Early identification of predictors for a poor long-term outcome in patients who survive the initial phase of out-of-hospital cardiac arrest (OHCA) may facilitate future clinical research, the process of care and information provided to relatives. The aim of this study was to determine the association between variables available from the patient’s history and status at intensive care admission with outcome in unconscious survivors of OHCA. Methods Using the cohort of the Target Temperature Management trial, we performed a post hoc analysis of 933 unconscious patients with OHCA of presumed cardiac cause who had a complete 6-month follow-up. Outcomes were survival and neurological function as defined by the Cerebral Performance Category (CPC) scale at 6 months after OHCA. After multiple imputations to compensate for missing data, backward stepwise multivariable logistic regression was applied to identify factors independently predictive of a poor outcome (CPC 3–5). On the basis of these factors, a risk score for poor outcome was constructed. Results We identified ten independent predictors of a poor outcome: older age, cardiac arrest occurring at home, initial rhythm other than ventricular fibrillation/tachycardia, longer duration of no flow, longer duration of low flow, administration of adrenaline, bilateral absence of corneal and pupillary reflexes, Glasgow Coma Scale motor response 1, lower pH and a partial pressure of carbon dioxide in arterial blood value lower than 4.5 kPa at hospital admission. A risk score based on the impact of each of these variables in the model yielded a median (range) AUC of 0.842 (0.840–0.845) and good calibration. Internal validation of the score using bootstrapping yielded a median (range) AUC corrected for optimism of 0.818 (0.816–0.821). Conclusions Among variables available at admission to intensive care, we identified ten independent predictors of a poor outcome at 6 months for initial survivors of OHCA. They reflected pre-hospital circumstances (six variables) and patient status on hospital admission (four variables). By using a simple and easy-to-use risk scoring system based on these variables, patients at high risk for a poor outcome after OHCA may be identified early.
Collapse
Affiliation(s)
- Louise Martinell
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE-413 45, Gothenburg, Sweden.
| | - Niklas Nielsen
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Johan Herlitz
- The Centre for Pre-hospital Research in Western Sweden, University College of Borås and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Karlsson
- Health Metrics at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Janneke Horn
- Department of Intensive Care, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Matt P Wise
- Adult Critical Care, University Hospital of Wales, Cardiff, UK
| | - Johan Undén
- Department of Intensive Care and Perioperative Medicine, Lund University, Malmö, Sweden
| | - Christian Rylander
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE-413 45, Gothenburg, Sweden
| |
Collapse
|
34
|
Jentzer JC, Clements CM, Murphy JG, Scott Wright R. Recent developments in the management of patients resuscitated from cardiac arrest. J Crit Care 2017; 39:97-107. [PMID: 28242531 DOI: 10.1016/j.jcrc.2017.02.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/18/2017] [Accepted: 02/01/2017] [Indexed: 01/31/2023]
Abstract
Cardiac arrest is the leading cause of death in Europe and the United States. Many patients who are initially resuscitated die in the hospital, and hospital survivors often have substantial neurologic dysfunction. Most cardiac arrests are caused by coronary artery disease; patients with coronary artery disease likely benefit from early coronary angiography and intervention. After resuscitation, cardiac arrest patients remain critically ill and frequently suffer cardiogenic shock and multiorgan failure. Early cardiopulmonary stabilization is important to prevent worsening organ injury. To achieve best patient outcomes, comprehensive critical care management is needed, with primary goals of stabilizing hemodynamics and preventing progressive brain injury. Targeted temperature management is frequently recommended for comatose survivors of cardiac arrest to mitigate the neurologic injury that drives outcomes. Accurate neurologic assessment is central to managing care of cardiac arrest survivors and should combine physical examination with objective neurologic testing, with the caveat that delaying neurologic prognosis is essential to avoid premature withdrawal of supportive care. A combination of clinical findings and diagnostic results should be used to estimate the likelihood of functional recovery. This review focuses on recent advances in care and specific cardiac intensive care strategies that may improve morbidity and mortality for patients after cardiac arrest.
Collapse
Affiliation(s)
- Jacob C Jentzer
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
| | | | - Joseph G Murphy
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - R Scott Wright
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| |
Collapse
|
35
|
DHA-supplemented diet increases the survival of rats following asphyxia-induced cardiac arrest and cardiopulmonary bypass resuscitation. Sci Rep 2016; 6:36545. [PMID: 27811958 PMCID: PMC5109906 DOI: 10.1038/srep36545] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 10/17/2016] [Indexed: 12/27/2022] Open
Abstract
Accumulating evidence illustrates the beneficial effects of dietary docosahexaenoic acid (DHA) on cardiovascular diseases. However, its effects on cardiac arrest (CA) remain controversial in epidemiological studies and have not been reported in controlled animal studies. Here, we examined whether dietary DHA can improve survival, the most important endpoint in CA. Male Sprague-Dawley rats were randomized into two groups and received either a control diet or a DHA-supplemented diet for 7–8 weeks. Rats were then subjected to 20 min asphyxia-induced cardiac arrest followed by 30 min cardiopulmonary bypass resuscitation. Rat survival was monitored for additional 3.5 h following resuscitation. In the control group, 1 of 9 rats survived for 4 h, whereas 6 of 9 rats survived in the DHA-treated group. Surviving rats in the DHA-treated group displayed moderately improved hemodynamics compared to rats in the control group 1 h after the start of resuscitation. Rats in the control group showed no sign of brain function whereas rats in the DHA-treated group had recurrent seizures and spontaneous respiration, suggesting dietary DHA also protects the brain. Overall, our study shows that dietary DHA significantly improves rat survival following 20 min of severe CA.
Collapse
|