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- Title
Early Identification of Patients With Out-of-Hospital Cardiac Arrest With No Chance of Survival and Consideration for Organ Donation.
- Authors
Jabre, Patricia; Bougouin, Wulfran; Dumas, Florence; Carli, Pierre; Antoine, Corinne; Jacob, Laurent; Dahan, Benjamin; Beganton, Frankie; Empana, Jean-Philippe; Marijon, Eloi; Karam, Nicole; Loupy, Alexandre; Lefaucheur, Carmen; Jost, Daniel; Cariou, Alain; Adnet, Frédéric; Rea, Thomas D.; Jouven, Xavier
- Abstract
<bold>Background: </bold>In patients with out-of-hospital cardiac arrest (OHCA), care requirements can conflict with the need to promptly focus efforts on organ donation in patients who are pronounced dead.<bold>Objective: </bold>To evaluate objective criteria for identifying patients with OHCA with no chance of survival during the first minutes of cardiopulmonary resuscitation to enable prompt orientation toward organ donation.<bold>Design: </bold>Retrospective assessment using OHCA data from 2 registries and 1 trial.<bold>Setting: </bold>France (Paris Sudden Death Expertise Center [SDEC] prospective cohort [2011 to 2014] and PRESENCE multicenter cluster randomized trial [ClinicalTrials.gov: NCT01009606] [2009 to 2011]) and the United States (King County, Washington, prospective cohort [2006 to 2011]).<bold>Patients: </bold>1771 patients from the Paris SDEC 1-year cohort (2011 to 2012) and 5192 from the validation cohorts.<bold>Measurements: </bold>Evaluation of 3 objective criteria (OHCA not witnessed by emergency medical services personnel, nonshockable initial cardiac rhythm, and no return of spontaneous circulation before receipt of a third 1-mg dose of epinephrine), survival rate at hospital discharge among patients meeting these criteria, performance of the criteria, and number of patients eligible for organ donation.<bold>Results: </bold>In the Paris SDEC 1-year cohort, the survival rate among the 772 patients with OHCA who met the objective criteria was 0% (95% CI, 0.0% to 0.5%), with a specificity of 100% (CI, 97% to 100%) and a positive predictive value of 100% (CI, 99% to 100%). These results were verified in the validation cohorts. Ninety-five (12%) patients in the Paris SDEC 1-year cohort may have been eligible for organ donation.<bold>Limitation: </bold>Several patients had unknown outcomes.<bold>Conclusion: </bold>Three objective criteria enable the early identification of patients with OHCA with essentially no chance of survival and may help in decision making about the organ donation process.<bold>Primary Funding Source: </bold>French Ministry of Health.
- Subjects
FRANCE; UNITED States; CARDIAC arrest; ORGAN donation; HOSPITAL patients; CARDIOPULMONARY resuscitation; MEDICAL decision making; SECONDARY analysis; RETROSPECTIVE studies; EARLY diagnosis
- Publication
Annals of Internal Medicine, 2016, Vol 165, Issue 11, p770
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/M16-0402