An integrated program of extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation and uncontrolled donation after circulatory determination of death in refractory cardiac arrest

• Type: Article in International Scientific Journal
• Date: 2018

Authors

Roncon-Albuquerque R Jr (Author) FMUP; Sergio Gaiao (Author) FMUP; Araújo JP (Author) FMUP; Principe, N (Author) Other; Basilio, C (Author) Other; Mergulhao, P (Author) FMUP; Silva, S (Author) Other; Honrado, T (Author) Other; Francisco Cruz (Author) FMUP; Pestana M (Author) FMUP; José Oliveira (Author) FMUP; Meira, L (Author) Other; Franca, A (Author) Other; Almeida Sousa, JP (Author) Other; araujo, f (Author) FMUP; Paiva, J-A (Author) FMUP

Journal

Title: Resuscitation

Vol. 133

Pages: 88-94

ISSN: 0300-9572

Publisher: Elsevier

Indexing

ISI Web of Knowledge - 31 Citations

Scopus - 33 Citations

Other information

Authenticus ID: P-00P-RCM

DOI: 10.1016/j.resuscitation.2018.10.016

Abstract (EN): Aim: To assess the feasibility of an integrated program of extracorporeal cardiopulmonary resuscitation (ECPR) and uncontrolled donation after circulatory determination of death (uDCDD) in refractory cardiac arrest (rCA). Methods: Single center, prospective, observational study of selected patients with in-hospital (IHCA) and out-of-hospital (OHCA) rCA occurring in an urban area of similar to 1.5 million inhabitants, between October-2016 and May-2018. 65 year old or younger patients without significant bleeding or comorbidities with witnessed nonasystolic cardiac arrests were triaged to ECPR if they had a reversible cause and high quality CPR lasting < 60 min. Otherwise they were considered for uDCDD after a ten minute no touch period using normothermic regional perfusion. Results: 58 patients were included, of which 41 (71%) were OHCA and 18 (31%) had ECPR initiated. Median age was 52 (IQR 45-56) years. Cannulation was successful in 49/58 (84%) cases. Compared to ECPR, patients referred for uDCDD were more frequently OHCA (90 vs. 28%), had bystander CPR (28 vs. 83%) and prolonged low-flow period (40 (35-50) vs. 60 (49-78) min). Survival to hospital discharge with full neurological recovery (cerebral performance category 1) occurred in 6/18 (33%) ECPR patients. uDCDD resulted in transplantation of 44 kidneys. Conclusions: An integrated program for rCA consisting of a formal pathway to uDCDD referral in ECPR ineligible patients is feasible. ECPR-referred patients had a reasonable survival with full neurologic recovery. Successful kidney transplantation was achieved with uDCDD.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 7