Extracorporeal cardiopulmonary resuscitation (ECPR) may improve survival in refractory out-of-hospital cardiac arrest (OHCA) but also expand the donor pool as these patients often become eligible for organ donation. Our aim is to describe the impact of organ donation in OHCA patients treated with ECPR in a high-volume cardiac arrest centre. Rate of organ donation (primary outcome), organs harvested, a composite of patient survival with favourable neurological outcome or donation of ≥1 solid organ (ECPR benefit), and the potential total number of individuals benefiting from ECPR (survivors with favourable neurological outcome and potential recipients of one solid organ) were analysed among all-rhythms refractory OHCA patients treated with ECPR between January 2013–November 2022 at San Raffaele Hospital in Milan, Italy. Among 307 adults with refractory OHCA treated with ECPR (95% witnessed, 66% shockable, low-flow 70 [IQR 58–81] minutes), 256 (83%) died during hospital stay, 33% from brain death. Donation of at least one solid organ occurred in 58 (19%) patients, 53 (17%) after determination of brain death and 5 (1.6%) after determination of circulatory death, contributing a total of 167 solid organs (3.0 [IQR 2.5–4.0] organs/donor). Overall, 196 individuals (29 survivors with favourable neurological outcome and 167 potential recipients of 1 solid organ) possibly benefited from ECPR. ECPR benefit composite outcome was achieved in 87 (28%) patients. Solid organ donation decreased from 19% to 16% in patients with low-flow <60 min and to 11% with low-flow <60 min and initial shockable rhythm. When ECPR fails in patients with refractory OHCA, organ donation after brain or circulatory death can help a significant number of patients awaiting transplantation, enhancing the overall benefit of ECPR. ECPR selection criteria may affect the number of potential organ donors.

中文翻译：

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意大利米兰大都会心脏骤停中心对难治性院外心脏骤停进行体外心肺复苏后的器官捐献

体外心肺复苏 (ECPR) 可以改善难治性院外心脏骤停 (OHCA) 的生存率，但也可以扩大捐赠者库，因为这些患者通常有资格进行器官捐赠。我们的目的是描述器官捐献对在大容量心脏骤停中心接受 ECPR 治疗的 OHCA 患者的影响。器官捐献率（主要结果）、器官收获率、具有良好神经学结果的患者生存率或捐赠 ≥1 个实体器官（ECPR 获益）的综合数据，以及受益于 ECPR 的潜在总人数（具有良好神经学结果的幸存者和对 2013 年 1 月至 2022 年 11 月期间在意大利米兰圣拉斐尔医院接受 ECPR 治疗的全心律难治性 OHCA 患者进行了分析。在接受 ECPR 治疗的 307 名难治性 OHCA 成人中（95% 为目击者，66% 为电击者，低流量 70 [IQR 58–81] 分钟），256 人 (83%) 在住院期间死亡，33% 死于脑死亡。 58 名（19%）患者捐献了至少一个实体器官，其中 53 名（17%）在确定脑死亡后捐献，5 名（1.6%）在确定循环死亡后捐献，总共捐献了 167 个实体器官（3.0 [IQR 2.5]） –4.0]器官/捐赠者）。总体而言，196 人（29 名具有良好神经学结果的幸存者和 167 名 1 个实体器官的潜在接受者）可能从 ECPR 中受益。 87 名 (28%) 患者实现了 ECPR 获益综合结果。低流量<60分钟的患者的实体器官捐献率从19%下降到16%，低流量<60分钟且初始可电击心律的患者的实体器官捐献率从11%下降到11%。当 ECPR 对难治性 OHCA 患者失败时，脑死亡或循环死亡后的器官捐献可以帮助大量等待移植的患者，从而增强 ECPR 的整体益处。 ECPR 选择标准可能会影响潜在器官捐献者的数量。