Identifying Potential Organ Donors Quickly After Unsurvivable Out-of-Hospital Cardiac Arrest

Summary and Comment |
September 12, 2016

Identifying Potential Organ Donors Quickly After Unsurvivable Out-of-Hospital Cardiac Arrest

  1. Ali S. Raja, MD, MBA, MPH, FACEP

Use of this validated decision instrument might allow discussions around organ donation to begin earlier.

  1. Ali S. Raja, MD, MBA, MPH, FACEP

Patients who suffer out-of-hospital cardiac arrest (OHCA) have poor survival rates. Nevertheless, resuscitative efforts can often take hours, and it is only after this that discussions regarding potential organ donation are initiated. While an ever-increasing number of people are noting a willingness to have their organs donated (e.g., on their driver's licenses), the need for donor organs has also continued to rise. Given this, discussions regarding organ donation with the families of patients with unsurvivable OHCA should begin as early as possible.

Researchers reviewed the literature and developed a three-criteria decision instrument to identify patients with unsurvivable OHCA. The criteria are as follows:

  • OHCA unwitnessed by emergency medical services or medical personnel

  • Nonshockable initial rhythm

  • Lack of return of spontaneous circulation before receipt of a third dose of 1 mg epinephrine

The researchers retrospectively evaluated the decision instrument in their local population in Paris and then retrospectively validated it both locally and using a cardiac arrest registry from the U.S.

Of 6962 patients in the combined cohorts, 2800 (40.2%) met all three criteria. Of these, 2799 died and 1 survived. Of the 2342 French patients who met all three criteria, 217 (9%) might have been eligible for organ donation according to French requirements.

Comment

Organ donation might be the one positive outcome from a futile OHCA resuscitation. For patients who present to the emergency department after OHCA, the earlier futility is established, the earlier we can consider organ donation. This tool might help providers recognize futility earlier — or just reaffirm a very difficult decision — and allow the organ donation process to start sooner.

Editor Disclosures at Time of Publication

  • Disclosures for Ali S. Raja, MD, MBA, MPH, FACEP at time of publication Speaker's bureau Airway Management Education Center Leadership positions in professional societies Society for Academic Emergency Medicine (Board Member); American College of Emergency Physicians (Chair, Trauma and Injury Prevention Section)

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