title: The rate of brain death and organ donation in patients resuscitated from cardiac arrest: a systematic review and meta-analysis.
abstract: BACKGROUND
  The occurrence of brain death in patients with hypoxic-ischaemic brain injury after resuscitation from cardiac arrest creates opportunities for organ donation. However, its prevalence is currently unknown.
  
  
  METHODS
  Systematic review. MEDLINE via PubMed, ISI Web of Science and the Cochrane Database of Systematic Reviews were searched for eligible studies (2002-2016). The prevalence of brain death in adult patients resuscitated from cardiac arrest and the rate of organ donation among brain dead patients were summarised using a random effect model with double-arcsine transformation. The quality of evidence (QOE) was evaluated according to the GRADE guidelines.
  
  
  RESULTS
  26 studies [16 on conventional cardiopulmonary resuscitation (c-CPR), 10 on extracorporeal CPR (e-CPR)] included a total of 23,388 patients, 1830 of whom developed brain death at a mean time of 3.2 ± 0.4 days after recovery of circulation. The overall prevalence of brain death among patients who died before hospital discharge was 12.6 [10.2-15.2] %. Prevalence was significantly higher in e-CPR vs. c-CPR patients (27.9 [19.7-36.6] vs. 8.3 [6.5-10.4] %; p < 0.0001). The overall rate of organ donation among brain dead patients was 41.8 [20.2-51.0] % (9/26 studies, 1264 patients; range 0-100 %). The QOE was very low for both outcomes.
  
  
  CONCLUSIONS
  In patients with hypoxic-ischaemic brain injury following CPR, more than 10 % of deaths were due to brain death. More than 40 % of brain-dead patients could donate organs. Patients who are unconscious after resuscitation from cardiac arrest, especially when resuscitated using e-CPR, should be carefully screened for signs of brain death.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Largo Agostino Gemelli 8, 00168, Rome, Italy. sandroni@rm.unicatt.it.
authors.forename: Claudio
authors.identifier: http://orcid.org/0000-0002-8878-2611
authors.initials: C
authors.lastname: Sandroni
authors.affiliation: Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Largo Agostino Gemelli 8, 00168, Rome, Italy.
authors.forename: Sonia
authors.initials: S
authors.lastname: D'Arrigo
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Clifton W
authors.initials: CW
authors.lastname: Callaway
authors.affiliation: Medical ICU, Cochin Hospital (AP-HP) Paris Descartes University, Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Cariou
authors.affiliation: Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden.
authors.forename: Irina
authors.initials: I
authors.lastname: Dragancea
authors.affiliation: Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Fabio Silvio
authors.initials: FS
authors.lastname: Taccone
authors.affiliation: Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Largo Agostino Gemelli 8, 00168, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Antonelli
mesh_terms: D001926:Brain Death; D016887:Cardiopulmonary Resuscitation / Q000401:mortality / Q000706:statistics & numerical data*; D002423:Cause of Death; D005260:Female; D006323:Heart Arrest / Q000401:mortality*; D006801:Humans; D008297:Male; D016377:Organ Transplantation / Q000706:statistics & numerical data*; D015995:Prevalence; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*
keywords: Anoxia-ischemia, brain; Brain death; Cardiac arrest; Organ donation