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

• Published in: Resuscitation 2018-12, Vol.133, p.88-94
• Main Authors: Roncon-Albuquerque, Roberto, Gaião, Sérgio, Figueiredo, Paulo, Príncipe, Nuno, Basílio, Carla, Mergulhão, Paulo, Silva, Sofia, Honrado, Teresa, Cruz, Francisco, Pestana, Manuel, Oliveira, Gerardo, Meira, Luis, França, Ana, Almeida-Sousa, João Paulo, Araújo, Fernando, Paiva, José-Artur
• Format: Article
• Language: English
• Subjects: ECMO assisted cardiopulmonary resuscitation; Extracorporeal membrane oxygenation (ECMO); Refractory cardiac arrest; Uncontrolled donation after circulatory determination of death (uDCDD)
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2018.10.016

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). Single center, prospective, observational study of selected patients with in-hospital (IHCA) and out-of-hospital (OHCA) rCA occurring in an urban area of ∼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. 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. 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.