Early ID of nonsurvivable cardiac arrest aids in prompt organ donation efforts
Three objective criteria may help identify out-of-hospital cardiac arrest with no foreseeable chance of survival and have the potential to aid in the organ donation decision-making process, according to study results published in Annals of Internal Medicine.
“For patients with out-of-hospital cardiac arrest, the prehospital emergency medical services team must perform standard cardiopulmonary resuscitation (CPR) and consider all available technologies... to save the patient’s life. However, despite improvements in resuscitation techniques used by prehospital [emergency medical services] and in-hospital intensivists, most patients with [out-of-hospital cardiac arrest] do not survive: Mortality remains as high as 92% to 94%,” Patricia Jabre, MD, PhD, of Hôpital Necker-Enfants Malades in Paris, France, and colleagues wrote. “Delays in recognizing futile resuscitative efforts result in lost opportunities to direct efforts toward donation of potentially viable organs.”
Jabre and colleagues performed a retrospective assessment of two registries (Paris Sudden Death Expertise Center [SDEC] registry from 2011 to 2012 and King County emergency medical services registry) and one trial (PRESENCE study) to analyze the efficiency of three objective criteria for detecting patients with nonsurvivable out-of-hospital cardiac arrest within the first minutes of advanced CPR.
The assessment included data from 1,771 patients within the Paris SDEC cohort and 5,192 patients within the King County and PRESENCE cohorts.
Objective criteria assessed included these three factors: cardiac arrest not seen by emergency medical services, initial cardiac rhythm that was nonshockable, and return of spontaneous circulation not sustainable prior to receiving of a third 1-mg dose of epinephrine.
The researchers found that among the patients who met the three objective criteria within the Paris SDEC cohort (n = 772), 0% survived (95% CI, 0.0-0.5). This survival rate had a specificity of 100% (95% CI, 97-100) and a positive predictive value of 100% (CI, 99-100). The King County and PRESENCE cohorts replicated these results.
Organ donation eligibility was plausible in approximately 95 patients (12%) from the Paris SDEC cohort.
“The findings of this study can help out-of-hospital [emergency medical services] teams employing physicians or paramedics in the process of deciding between early transport to the hospital or termination of resuscitation...” Jabre and colleagues concluded. “In some cases, refocusing efforts toward the maintenance of potentially viable organs for donation might make it possible to save other lives.” – by Alaina Tedesco
Disclosure: Jabre reports funding from the French Ministry of Health. Please see the full study for a complete list of all other authors’ relevant financial disclosures.