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


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


METHODS
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]).


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


METHODS
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.


CONCLUSIONS
Several patients had unknown outcomes.


CONCLUSIONS
Three 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.


BACKGROUND
French Ministry of Health.
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.
Patricia
P
Jabre
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.
Wulfran
W
Bougouin
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.
Florence
F
Dumas
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.
Pierre
P
Carli
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.
Corinne
C
Antoine
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.
Laurent
L
Jacob
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.
Benjamin
B
Dahan
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.
Frankie
F
Beganton
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.
Jean-Philippe
JP
Empana
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.
Eloi
E
Marijon
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.
Nicole
N
Karam
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.
Alexandre
A
Loupy
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.
Carmen
C
Lefaucheur
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.
Daniel
D
Jost
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.
Alain
A
Cariou
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.
Frédéric
F
Adnet
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.
Thomas D
TD
Rea
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.
Xavier
X
Jouven
D000368:Aged; D000066491:Clinical Decision-Making; D042241:Early Diagnosis; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis* / Q000401:mortality*; D012189:Retrospective Studies; D009927:Tissue and Organ Procurement; D014481:United States / Q000453:epidemiology