C Marano

Are patients brain-dead after successful resuscitation from cardiac arrest suitable as organ donors? A systematic review

AIM To compare the outcome of organs retrieved from patients brain dead due to cardiac arrest (CA) with that of organs retrieved from patients brain dead due to other causes (non-CA). METHODS Systematic review. Clinical studies comparing the outcome of patients and organs retrieved from donors brain dead after being resuscitated from cardiac arrest with that of patients and organs retrieved from donors brain dead not due to cardiac arrest were considered for inclusion. Full-text articles were searched on MEDLINE, EmBASE, Cochrane Register of Controlled Trials and Cochrane Register of Systematic Reviews. MAIN OUTCOME MEASURE One-year patient or organ survival rate. RESULTS Four studies fulfilling inclusion criteria were found and three had sufficient quality to be included in final analysis. A total of 858 organs were transplanted from 741 donors. Since the transplanted organs (heart, liver, kidney, lung and intestine) were different in the three studies, metanalysis was not performed. There were no significant differences in 1-year survival rates between CA and non-CA groups. No significant differences were reported for 5-year survival rates, early recovery of transplanted organ function, and organ rejection rates. CONCLUSION Survival rates of kidneys, livers, hearts and intestines retrieved from CA donors were not significantly different from that of organs transplanted from non-CA donors. Patients brain dead after having been resuscitated from cardiac arrest can be considered as potential donors for organ transplantation.

Good neurological recovery after cardiopulmonary resuscitation and thrombolysis in two old patients with pulmonary embolism

The use of thrombolysis as an emergency treatment for cardiac arrest (CA) due to massive pulmonary embolism (MPE) has been described. However, there are no reports of successful treatment of MPE‐associated CA in patients over 77 years of age. We report two cases of successful cardiopulmonary resuscitation for an MPE‐associated CA in two very old women (87 and 86 years of age). In both cases, typical signs of MPE were documented using emergency echocardiography, which showed an acute right ventricle enlargement and a paradoxical movement of the interventricular septum. Emergency thrombolysis was administered during resuscitation, which lasted 45 and 21 min, respectively. Despite old age and prolonged resuscitation efforts, both patients had good neurological recovery and one of them was alive and neurologically intact 1 year later. Thrombolysis is a potentially useful therapy in MPE‐associated CA. A good neurological outcome can be obtained even in very old patients and after prolonged resuscitation.