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The rate of brain death and organ donation in patients resuscitated from cardiac arrest : a systematic review and meta-analysis

Sandroni, Claudio; D’Arrigo, Sonia; Callaway, Clifton W.; Cariou, Alain; Dragancea, Irina LU ; Taccone, Fabio Silvio and Antonelli, Massimo (2016) In Intensive Care Medicine 42(11). p.1661-1671
Abstract

Background: The occurrence of brain death in patients with hypoxic-ischaemic brain injury after resuscitation from cardiac arrest creates opportunities for organ donation. However, its prevalence is currently unknown. Methods: Systematic review. MEDLINE via PubMed, ISI Web of Science and the Cochrane Database of Systematic Reviews were searched for eligible studies (2002–2016). The prevalence of brain death in adult patients resuscitated from cardiac arrest and the rate of organ donation among brain dead patients were summarised using a random effect model with double-arcsine transformation. The quality of evidence (QOE) was evaluated according to the GRADE guidelines. Results: 26 studies [16 on conventional cardiopulmonary... (More)

Background: The occurrence of brain death in patients with hypoxic-ischaemic brain injury after resuscitation from cardiac arrest creates opportunities for organ donation. However, its prevalence is currently unknown. Methods: Systematic review. MEDLINE via PubMed, ISI Web of Science and the Cochrane Database of Systematic Reviews were searched for eligible studies (2002–2016). The prevalence of brain death in adult patients resuscitated from cardiac arrest and the rate of organ donation among brain dead patients were summarised using a random effect model with double-arcsine transformation. The quality of evidence (QOE) was evaluated according to the GRADE guidelines. Results: 26 studies [16 on conventional cardiopulmonary resuscitation (c-CPR), 10 on extracorporeal CPR (e-CPR)] included a total of 23,388 patients, 1830 of whom developed brain death at a mean time of 3.2 ± 0.4 days after recovery of circulation. The overall prevalence of brain death among patients who died before hospital discharge was 12.6 [10.2–15.2] %. Prevalence was significantly higher in e-CPR vs. c-CPR patients (27.9 [19.7–36.6] vs. 8.3 [6.5–10.4] %; p < 0.0001). The overall rate of organ donation among brain dead patients was 41.8 [20.2–51.0] % (9/26 studies, 1264 patients; range 0–100 %). The QOE was very low for both outcomes. Conclusions: In patients with hypoxic-ischaemic brain injury following CPR, more than 10 % of deaths were due to brain death. More than 40 % of brain-dead patients could donate organs. Patients who are unconscious after resuscitation from cardiac arrest, especially when resuscitated using e-CPR, should be carefully screened for signs of brain death.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Anoxia-ischemia, brain, Brain death, Cardiac arrest, Organ donation
in
Intensive Care Medicine
volume
42
issue
11
pages
11 pages
publisher
Springer
external identifiers
  • scopus:84989907135
  • wos:000386561900003
ISSN
0342-4642
DOI
10.1007/s00134-016-4549-3
language
English
LU publication?
yes
id
5c8018e5-1c9b-4fca-82cc-bdd5c2bc7eef
date added to LUP
2016-10-21 10:36:48
date last changed
2017-11-05 05:08:25
@article{5c8018e5-1c9b-4fca-82cc-bdd5c2bc7eef,
  abstract     = {<p>Background: The occurrence of brain death in patients with hypoxic-ischaemic brain injury after resuscitation from cardiac arrest creates opportunities for organ donation. However, its prevalence is currently unknown. Methods: Systematic review. MEDLINE via PubMed, ISI Web of Science and the Cochrane Database of Systematic Reviews were searched for eligible studies (2002–2016). The prevalence of brain death in adult patients resuscitated from cardiac arrest and the rate of organ donation among brain dead patients were summarised using a random effect model with double-arcsine transformation. The quality of evidence (QOE) was evaluated according to the GRADE guidelines. Results: 26 studies [16 on conventional cardiopulmonary resuscitation (c-CPR), 10 on extracorporeal CPR (e-CPR)] included a total of 23,388 patients, 1830 of whom developed brain death at a mean time of 3.2 ± 0.4 days after recovery of circulation. The overall prevalence of brain death among patients who died before hospital discharge was 12.6 [10.2–15.2] %. Prevalence was significantly higher in e-CPR vs. c-CPR patients (27.9 [19.7–36.6] vs. 8.3 [6.5–10.4] %; p &lt; 0.0001). The overall rate of organ donation among brain dead patients was 41.8 [20.2–51.0] % (9/26 studies, 1264 patients; range 0–100 %). The QOE was very low for both outcomes. Conclusions: In patients with hypoxic-ischaemic brain injury following CPR, more than 10 % of deaths were due to brain death. More than 40 % of brain-dead patients could donate organs. Patients who are unconscious after resuscitation from cardiac arrest, especially when resuscitated using e-CPR, should be carefully screened for signs of brain death.</p>},
  author       = {Sandroni, Claudio and D’Arrigo, Sonia and Callaway, Clifton W. and Cariou, Alain and Dragancea, Irina and Taccone, Fabio Silvio and Antonelli, Massimo},
  issn         = {0342-4642},
  keyword      = {Anoxia-ischemia, brain,Brain death,Cardiac arrest,Organ donation},
  language     = {eng},
  number       = {11},
  pages        = {1661--1671},
  publisher    = {Springer},
  series       = {Intensive Care Medicine},
  title        = {The rate of brain death and organ donation in patients resuscitated from cardiac arrest : a systematic review and meta-analysis},
  url          = {http://dx.doi.org/10.1007/s00134-016-4549-3},
  volume       = {42},
  year         = {2016},
}