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Early Identification of Patients With Out-of-Hospital Cardiac Arrest With No Chance of Survival and Consideration for Organ DonationOut-of-Hospital Cardiac Arrest and Consideration for Organ Donation ONLINE FIRST

Patricia Jabre, MD, PhD; Wulfran Bougouin, MD, MPH; Florence Dumas, MD, PhD; Pierre Carli, MD, PhD; Corinne Antoine, MD; Laurent Jacob, MD, PhD; Benjamin Dahan, MD; Frankie Beganton, MS; Jean-Philippe Empana, MD, PhD; Eloi Marijon, MD, PhD; Nicole Karam, MD, MPH; Alexandre Loupy, MD, PhD; Carmen Lefaucheur, MD, PhD; Daniel Jost, MD, PhD; Alain Cariou, MD, PhD; Frédéric Adnet, MD, PhD; Thomas D. Rea, MD, MPH; and Xavier Jouven, MD, PhD
[+] Article, Author, and Disclosure Information

This article was published at www.annals.org on 13 September 2016.


From Paris Cardiovascular Research Center, Hôpital Necker-Enfants Malades, Hôpital Cochin, Université Paris Descartes-Sorbonne Paris Cité, Hôpital Saint-Louis, Université Paris Diderot – Paris VII, Hôpital Européen Georges Pompidou, and Paris Fire Brigade, Paris, France; Hôpital Avicenne, Université Paris 13, Bobigny, France; and Public Health–Seattle & King County and University of Washington, Seattle, Washington.

Acknowledgment: The authors thank the physicians, paramedics, nurses, and ambulance attendants at each center for their valuable cooperation in the study. A list of the Paris SDEC Investigators is provided in the Appendix.

Financial Support: The PRESENCE trial was supported by the Programme Hospitalier de Recherche Clinique 2008 of the French Ministry of Health and by the Research Delegation of the Assistance Publique – Hôpitaux de Paris.

Disclosures: Dr. Jabre reports a grant from the French Ministry of Health during the conduct of the study. Pr. Jacob reports personal fees from AbbVie, Alere, BioPorto, and Fresenius outside the submitted work. Pr. Adnet reports a grant from the French Ministry of Health during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-0402.

Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.

Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Available from Pr. Jouven (e-mail, xavier.jouven@inserm.fr).

Requests for Single Reprints: Xavier Jouven, MD, PhD, Cardiology Department, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France; e-mail, xavier.jouven@egp.aphp.fr.

Current Author Addresses: Dr. Jabre: SAMU de Paris, Hôpital Necker-Enfants Malades, 149 Rue de Sevres, 75015 Paris, France.

Dr. Bougouin and Pr. Jouven: Cardiology Department, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France.

Drs. Dumas, Dahan, Empana, Karam, Loupy, and Lefaucheur and Mr. Beganton: Paris Cardiovascular Research Center, INSERM Unit 970, 56 rue Leblanc, 75015 Paris, France.

Pr. Carli: SAMU 75, Necker University Hospital, 149 rue de Sèvres, 75015 Paris, France.

Dr. Antoine: Agence de la Biomédecine, 1 Avenue du Stade de France, 93212 Saint Denis, France.

Pr. Jacob: Service d’anesthésie réanimation, Hôpital Saint-Louis, 1 Avenue Claude Vellefeaux, 75010 Paris, France.

Dr. Marijon: Cardiology Department, Hôpital Européen Georges Pompidou, 20-40 Rue Leblanc, 75908 Paris, France.

Dr. Jost: Paris Fire Brigade, Medical Emergency Department, 1 place Jules Renard, 75009 Paris, France.

Pr. Cariou: Medical Intensive Care Unit, Cochin University Hospital, 27 rue du Faubourg Saint Jacques, 75014 Paris, France.

Pr. Adnet: AP-HP, SAMU 93, Urgences, Hôpital Avicenne, 125 rue de Stalingrad, 93000 Bobigny, France.

Pr. Rea: University of Washington, 401 5th Avenue, Suite 1200, Seattle, WA 98104.

Author Contributions: Conception and design: P. Jabre, X. Jouven.

Analysis and interpretation of the data: P. Jabre, W. Bougouin, F. Dumas, A. Loupy, A. Cariou, F. Adnet, T.D. Rea, X. Jouven.

Drafting of the article: P. Jabre, W. Bougouin, F. Dumas, A. Cariou, X. Jouven.

Critical revision of the article for important intellectual content: P. Jabre, L. Jacob, B. Dahan, J.P. Empana, E. Marijon, N. Karam, A. Loupy, C. Lefaucheur, A. Cariou, F. Adnet, T.D. Rea, X. Jouven.

Final approval of the article: P. Jabre, W. Bougouin, F. Dumas, P. Carli, C. Antoine, L. Jacob, B. Dahan, F. Beganton, J.P. Empana, E. Marijon, N. Karam, A. Loupy, C. Lefaucheur, D. Jost, A. Cariou, F. Adnet, T.D. Rea, X. Jouven.

Provision of study materials or patients: P. Jabre, W. Bougouin, P. Carli, L. Jacob, D. Jost, T.D. Rea, X. Jouven.

Statistical expertise: P. Jabre, W. Bougouin, J.P. Empana, X. Jouven.

Obtaining of funding: P. Jabre, E. Marijon.

Administrative, technical, or logistic support: P. Jabre, W. Bougouin, F. Dumas, P. Carli, L. Jacob, X. Jouven.

Collection and assembly of data: P. Jabre, W. Bougouin, F. Dumas, F. Beganton, D. Jost, F. Adnet, X. Jouven.


Ann Intern Med. Published online 13 September 2016 doi:10.7326/M16-0402
© 2016 American College of Physicians
Text Size: A A A

Background: 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.

Objective: 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.

Design: Retrospective assessment using OHCA data from 2 registries and 1 trial.

Setting: 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]).

Patients: 1771 patients from the Paris SDEC 1-year cohort (2011 to 2012) and 5192 from the validation cohorts.

Measurements: 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.

Results: 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.

Limitation: Several patients had unknown outcomes.

Conclusion: 3 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.

Primary Funding Source: French Ministry of Health.

Figures

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Figure 1.

Flow chart for the Paris Sudden Death Expertise Center 1-y cohort.

The cohort included patients with out-of-hospital cardiac arrest of presumed cardiac origin from 16 May 2011 to 15 May 2012. ACLS = advanced cardiac life support.

* Out-of-hospital cardiac arrest not witnessed by emergency medical services personnel, initial nonshockable rhythm, and no return of spontaneous circulation before receipt of a third 1-mg dose of epinephrine.

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Appendix Figure 1.

Flow chart of the Paris Sudden Death Expertise Center validation cohort.

The cohort included patients with out-of-hospital cardiac arrest of presumed cardiac origin from 16 May 2012 through 15 May 2014. ACLS = advanced cardiac life support.

* Out-of-hospital cardiac arrest not witnessed by emergency medical services personnel, initial nonshockable rhythm, and no return of spontaneous circulation before receipt of a third 1-mg dose of epinephrine.

† One patient survived to hospital discharge in a persistent vegetative state (Cerebral Performance Category score of 4).

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Appendix Figure 2.

Flow chart of the PRESENCE cohort.

OHCA = out-of-hospital cardiac arrest.

* OHCA not witnessed by emergency medical services personnel, initial nonshockable rhythm, and no return of spontaneous circulation before receipt of a third 1-mg dose of epinephrine.

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Appendix Figure 3.

Flow chart of the King County cohort.

OHCA = out-of-hospital cardiac arrest.

* OHCA not witnessed by emergency medical services personnel, initial nonshockable rhythm, and no return of spontaneous circulation before receipt of a third 1-mg dose of epinephrine.

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Figure 2.

Candidates for UDCD in the Paris Sudden Death Expertise Center 1-y cohort.

ACLS = advanced cardiac life support; CPR = cardiopulmonary resuscitation; UDCD = uncontrolled donation after cardiac death.

* Out-of-hospital cardiac arrest not witnessed by emergency medical services personnel, initial nonshockable rhythm, and no return of spontaneous circulation before receipt of a third 1-mg dose of epinephrine.

† Proposed by the French national protocol for kidney retrieval from UDCD (24).

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