The rate of brain death and organ donation in patients resuscitated from cardiac arrest: a systematic review and meta-analysis.
Sandroni C, D'Arrigo S, et al.Intensive Care Medicine 2016; 42(11): 1661-1671.
Aims
To determine the prevalence of brain death in adult patients with hypoxic-ischaemic brain injury after resuscitation from cardiac arrest, and measure the rate of organ donation in these patients.
Interventions
The databases Medline, Web of Science and the Cochrane Database of Systematic Reviews were searched up until 30th April 2016, as well as the websites of relevant journals and reference lists of relevant studies to identify all studies of interest and in press. Included studies were those published as full-text articles in indexed journals which reported the prevalence of brain death in adult patients resuscitated from cardiac arrest occurring either in-hospital or out-of-hospital.
Participants
26 studies (total 23,388 patients) were included in this systematic review.
Outcomes
The primary outcomes measured were the rate and timing of brain death and the rate of organ donation. Other measured outcomes included the location of cardiac arrest (in-hospital or out-of-hospital), witnessed status, cause of cardiac arrest, initial cardiac rhythm, CPR technique (extracorporeal or conventional), cardiac arrest duration, hospital mortality and mode of death.
Follow-up
Not reported
CET Conclusions
This systematic review aimed to establish the prevalence of brain death in adult patients resuscitated from cardiac arrest and the subsequent organ donation rate. Studies published after 2002 were identified through searches of Medline, Web of Science and the Cochrane Database of Systematic Reviews. Two independent reviewers rated the quality of the evidence using the GRADE criteria as very low. The quality of the individual studies was assessed using a modified version of the of the Quality Assessment Tool for Observational and Cross-sectional Studies but was not reported in the article. Twenty-six articles were included of which 10 articles reported on conventional CPR and 16 articles reported on extracorporeal CPR. The pooled prevalence of brain death was 13% among patients who died in hospital. Pooled rates of organ donation were 42% of brain deaths and 6% of all deaths. All pooled estimated showed significant heterogeneity (≥73%). The authors highlighted the potential for organ donation in brain-dead patients and included a suggested algorithm for brain death screening after cardiac death.
Quality notes
Quality assessment not appropriate
Trial registration
None