The rate of brain death and organ donation in patients resuscitated from cardiac arrest: a systematic review and meta-analysis.
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 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 braindead 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.
KEYWORDS:
Anoxia-ischemia, brain; Brain death; Cardiac arrest; Organ donation
Comment in
- CPR and brain death: confounders, clearance, caution. [Intensive Care Med. 2017]
- Authors’ response: CPR and brain death: confounders, clearance, caution. [Intensive Care Med. 2017]
- PMID:
- 27699457
- PMCID:
- PMC5069310
- DOI:
- 10.1007/s00134-016-4549-3
- [Indexed for MEDLINE]