Cardiopulmonary resuscitation does not affect donation in uncontrolled donation after circulatory death procedures

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• Study Objective and Context: The study evaluates whether the actions implemented to reverse an out-of-hospital cardiac arrest (CA) affect the subsequent efficacy of organ donation in the context of uncontrolled donation after circulatory death (UDCD). UDCD has become a crucial alternative for increasing organ availability for transplant due to donor shortages. • Key and Statistically Significant Results: Of the variables analyzed, only two actions showed a statistically significant difference between effective donors (at least one organ extracted and transplanted) and non-effective donors: ○ Adrenaline (Epinephrine): Effective donors received a mean of seven doses of adrenaline compared to eight for non-effective donors, with the difference being statistically significant (p=0.012). ○ Fibrinolysis: The use of fibrinolytic agents was significantly higher in the effective donor group (six cases, 24% of this group) compared to the non-effective donors (two cases, 4.7% of this group), and this difference was also statistically significant (p=0.044). • Main Conclusion of the Study: Despite the findings with adrenaline and fibrinolysis, the authors conclude that, based on their series, none of the actions implemented during CA to recover a spontaneous pulse appear to affect the effectiveness of donation in uncontrolled donation after circulatory death procedures (UDCD). The only exceptions appear to be the lower use of adrenaline and the use of fibrinolytic agents. The authors suggest that the limited difference in adrenaline values may be random 10 and point out that fibrinolytic agents are common treatments for donors in uncontrolled asystole, which may explain the greater effectiveness. The uncontrolled donation after circulatory death process is started upon cardiac arrest (CA). Although the initial objective of all emergency services is to recover a pulse after said CA, if this is not possible there is a possibility of initiating uncontrolled donation after circulatory death procedures. The aim of this study is to evaluate the actions implemented to resolve CA and how they may affect subsequent donation. A double-perspective observational study to study the association between the actions carried out to revert CA and the efficacy of donors in uncontrolled asystole. Data were collected between 2018 and November 2023. Patients who experienced an out-of-hospital CA with no response to advanced cardiopulmonary resuscitation, and who complied with all inclusion criteria and none of the exclusion criteria, were included. The following information was collected: age, sex, initial heart rate, adrenalin, amiodarone, serum therapy, inotropics, bicarbonate, magnesium sulfate, rapid intubation sequence, fibrinolysis, acetylsalicylic acid, atropine, number of defibrillations, use of an automatic defibrillator and discharges thereof, transitory recovery of pulse and initial heart rate. The statistical analysis was carried out using the R software package (ver. 4.1). An effective donor was defined as one from whom at least one organ was extracted and transplanted, and a non-effective donor as one from whom no organs were transplanted. A total of 69 patients, with a mean age of 49 years (43–52), the majority of whom were male (88.4%), were collected. A total of 43 of these patients were non-effective donors and 26 were effective, with a statistically significant difference being found in terms of younger age (51 vs 46; p=0.020). In the case of non-effective donors, eight adrenalin doses were administered compared with seven for the effective donor group, with the difference being statistically significant (p=0.012). Fibrinolysis was used in eight cases (11.8%), with two of these being non-effective donors and six effective; this difference was also statistically significant (p=0.044). The remaining variables did not differ significantly. On the basis of our series, only a lower use of adrenaline and the use of fibrinolytic agents appear to result in an effective donation if a pulse cannot be recovered. The other variables do not affect the efficacy of donation after uncontrolled circulatory death.

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