曾进行过心肺复苏的循环死亡后捐献者的使用率和心脏移植结果。

IF 3.2 2区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

International journal of cardiology Pub Date : 2024-11-15 DOI:10.1016/j.ijcard.2024.132727

Shivank Madan , Carles Díez-López , Snehal R. Patel , Omar Saeed , Stephen J. Forest , Daniel J. Goldstein , Michael M. Givertz , Ulrich P. Jorde

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引用次数: 0

摘要

背景：循环死亡（DCD）后的心脏捐献涉及因撤除生命支持（WLS）导致捐献者心脏骤停而必须暴露于温性缺血性损伤（WII）。然而，潜在的 DCD 捐献者也可能在撤除生命支持（WLS）之前经历心脏骤停和心肺复苏（CPR）以及相关的 WII。我们试图研究 DCD 心脏移植（HT）中先前供体心肺复苏的影响：方法：在 2020 年 1 月至 2023 年 4 月期间，我们在 UNOS 中确定了 11,415 例成人 HT，其中 9456 例符合研究标准，并有关于供体心肺复苏的信息。随访至 2024 年 4 月。研究队列根据 DCD 与脑死亡后捐献（DBD）状态和供体-CPR 分成四组，即 DCD/CPR+（n = 387）、DCD/no-CPR（n = 305）、DBD/CPR+（n = 5158）和 DBD/no-CPR（n = 3606）；并对 HT 的特征和结果进行比较：结果：以DBD/noCPR HT为参考队列，使用卡普兰-梅耶分析、未调整和调整后的Cox危险比模型，其他HT队列（DCD/CPR+、DCD/noCPR和DBD/CPR+）随访1年后的死亡率无显著差异。倾向匹配队列的结果相似。供体CPR持续时间（≤20分钟 vs >20分钟）不影响HT存活率；院内次要结果的发生率相似。成人 DCD/CPR+ （3.39% 至 9.71%）和 DCD/noCPR 供体（4.41% 至 10.34%）的使用率均显著增加（P 结论：DCD/CPR+ 和 DCD/noCPR 供体的使用率均显著增加，而 DCD/CPR+ 和 DCD/noCPR 供体的使用率均显著减少：DCD/CPR+和DCD/noCPR供体的使用率增长速度相当。很大一部分 DCD HT 来自曾进行过 CPR 的供体，但这与短期存活率下降无关。

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Utilization rates and heart transplantation outcomes of donation after circulatory death donors with prior cardiopulmonary resuscitation

Background

Heart donation after circulatory death (DCD) involves mandatory exposure to warm ischemic injury (WII) due to donor cardiac arrest resulting from withdrawal of life-support (WLS). However, potential DCD donors may also experience a cardiac arrest and undergo cardiopulmonary resuscitation (CPR) and associated WII before WLS. We sought to investigate the effect of previous donor-CPR in DCD heart-transplantation (HT).

Methods

Between January-2020 and April-2023, we identified 11,415 adult HTs in UNOS of whom 9456 met study criteria and had information on donor-CPR. Follow-up was available till April-2024. Study cohort was divided into four groups based on DCD vs. donation after brain death (DBD) status and donor-CPR i.e., DCD/CPR+ (n = 387), DCD/noCPR (n = 305), DBD/CPR+ (n = 5158) and DBD/noCPR (n = 3606); and compared for HT characteristics and outcomes.

Results

With DBD/noCPR HTs as reference cohort, there were no significant differences in mortality in other HT cohorts (DCD/CPR+, DCD/noCPR and DBD/CPR+) upto 1-year of follow up using Kaplan-Meier analysis; and both unadjusted and adjusted Cox hazards-ratio models. Results were similar in propensity-matched cohorts. Duration of donor-CPR (≤20 min vs >20 min) did not influence HT survival; and rates of in-hospital secondary outcomes were similar. The utilization rates of both adult DCD/CPR+ (3.39 % to 9.71 %) and DCD/noCPR donors (4.41 % to 10.34 %) increased significantly (p < 0.01) during study period.

Conclusions

The utilization rates of both DCD/CPR+ and DCD/noCPR donors have increased at an equal pace. A significant proportion of DCD HTs were from donors with prior CPR, but this was not associated with worse short-term survival.

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来源期刊

International journal of cardiology 医学-心血管系统

CiteScore

6.80

自引率

5.70%

发文量

758

审稿时长

44 days

期刊介绍： The International Journal of Cardiology is devoted to cardiology in the broadest sense. Both basic research and clinical papers can be submitted. The journal serves the interest of both practicing clinicians and researchers. In addition to original papers, we are launching a range of new manuscript types, including Consensus and Position Papers, Systematic Reviews, Meta-analyses, and Short communications. Case reports are no longer acceptable. Controversial techniques, issues on health policy and social medicine are discussed and serve as useful tools for encouraging debate.