Protocols for uncontrolled donation after circulatory death

• Published in: The Lancet (British edition) 2012-04, Vol.379 (9823), p.1275-1276
• Main Authors: Rodríguez-Arias, David, Deballon, Iván Ortega
• Format: Article
• Language: English
• Subjects: Angioplasty, Balloon, Coronary; Cardiopulmonary Resuscitation; Consciousness; CPR; Critical Care; Death; Ethics; Extracorporeal Membrane Oxygenation; Heart attacks; Humans; Hypothermia; Hypothermia, Induced; Internal Medicine; Intra-Aortic Balloon Pumping; Out-of-Hospital Cardiac Arrest - therapy; Practice Guidelines as Topic; Survival; Thrombolytic Therapy; Tissue and Organ Procurement - standards
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(11)61784-4

Non-conventional resuscitation involves several techniques, including thrombolysis treatment during CPR,3,8 transfer to the intensive care unit with induced mild hypothermia,5,6 ECMO as a bridge to extracorporeal life support devices in the intensive care unit,4 percutaneous coronary intervention in a catheterisation laboratory,9 and, if needed, insertion of an intra-aortic balloon pump.6 Emergency and intensive care services in many countries, including Austria, Sweden, Japan, France, and the USA, have reported that various combinations of these techniques are associated with promising survival rates with good neurological outcomes (cerebral performance categories scale 1-2) after discharge from hospital.3,5,9,10 As a result of increasing evidence to support the eff ectiveness of such interventions in selected patients, international resuscitation guidelines have been modifi ed and now recommend treatment of the known or suspected causes of refractory cardiac arrest before CPR is discontinued.11,12 Uncontrolled donation programmes that overlook this recommendation might be failing to off er the updated standard of treatment to certain patients with out-of-hospital cardiac arrest. [...] some interventions that are strictly intended to preserve the organs- eg, vasodilators, anticoagulants, and preservation fl uids- can actually compromise the patient's chances of survival.13 However, not all patients with out-ofhospital cardiac arrest are likely to benefi t from nonconventional resuscitation procedures.10 Criteria should be developed to classify patients as either entitled to these innovative therapies or suitable for organ donation.