关于器官捐赠做法和接受者结果的数据有限,特别是在比较经历过心脏骤停并接受体外心肺复苏(ECPR),然后进行静脉-动脉体外膜氧合(ECMO)拔管的供体时,与那些没有接受ECPR的心脏骤停患者相比。本研究旨在探索ECPR后的器官捐赠实践和结果,以增强我们对心脏骤停后捐赠潜力的理解。
我们使用日本器官移植网络数据库的数据进行了一项全国性的回顾性队列研究,涵盖2010年7月17日至2022年8月31日期间所有已故器官捐献者。我们包括至少经历过一次心脏骤停的捐赠者。在学习期间,接受ECMO治疗的患者不符合脑死亡的法律诊断.我们比较了ECPR和非ECPR组之间与每个捐赠者的管理和接受者的长期移植结果相关的时间框架。
在370名心脏骤停的脑死亡捐献者中,26人(7.0%)接受了ECPR,而344人(93.0%)没有接受;大多数是由于院外心脏骤停。ECPR后静脉动脉ECMO支持的中位持续时间为3天。与未接受ECPR的患者相比,ECPR组患者从入院到器官获取的间隔明显更长(13vs.9天,P=0.005)。ECPR组肺移植物存活率显著降低(对数秩检验P=0.009),其他器官移植存活率无显著差异。在有心脏骤停的160名循环死亡献血者中,27人(16.9%)接受了ECPR,133人(83.1%)没有接受ECPR。循环死亡和移植物存活后从入院到器官获取的时间间隔显示,ECPR和非ECPR组之间没有显着差异。ECPR和非ECPR组捐赠的器官数量相似,不管大脑或循环死亡。
这项全国性的研究表明,接受ECPR治疗的捐献者的肺移植物存活率较低,强调在ECPR后器官捐赠中需要有针对性的研究和方案调整。
Limited data are available on organ donation practices and recipient outcomes, particularly when comparing donors who experienced cardiac arrest and received extracorporeal cardiopulmonary resuscitation (ECPR) followed by veno-arterial extracorporeal membrane oxygenation (ECMO) decannulation, versus those who experienced cardiac arrest without receiving ECPR. This
study aims to explore organ donation practices and outcomes post-ECPR to enhance our understanding of the donation potential after cardiac arrest.
We conducted a nationwide retrospective cohort
study using data from the Japan Organ Transplant Network database, covering all deceased organ donors between July 17, 2010, and August 31, 2022. We included donors who experienced at least one episode of cardiac arrest. During the
study period, patients undergoing ECMO treatment were not eligible for a legal diagnosis of brain death. We compared the timeframes associated with each donor\'s management and the long-term graft outcomes of recipients between ECPR and non-ECPR groups.
Among 370 brain death donors with an episode of cardiac arrest, 26 (7.0%) received ECPR and 344 (93.0%) did not; the majority were due to out-of-hospital cardiac arrests. The median duration of veno-arterial ECMO support after ECPR was 3 days. Patients in the ECPR group had significantly longer intervals from admission to organ procurement compared to those not receiving ECPR (13 vs. 9 days, P = 0.005). Lung graft survival rates were significantly lower in the ECPR group (log-rank test P = 0.009), with no significant differences in other organ graft survival rates. Of 160 circulatory death donors with an episode of cardiac arrest, 27 (16.9%) received ECPR and 133 (83.1%) did not. Time intervals from admission to organ procurement following circulatory death and graft survival showed no significant differences between ECPR and non-ECPR groups. The number of organs donated was similar between the ECPR and non-ECPR groups, regardless of brain or circulatory death.
This nationwide
study reveals that lung graft survival was lower in recipients from ECPR-treated donors, highlighting the need for targeted research and protocol adjustments in post-ECPR organ donation.