Uncontrolled donation programs after out-of-hospital cardiac arrest. An estimation of potential donors.

OBJECTIVE: To determine the number of potential deceased organ donors from out-of- hospital cardiac arrest cases (OHCA) attended by public physician-led emergency medical services in Spain, based on data recorded in the nationwide Spanish OHCA Registry (OHSCAR). MATERIAL AND METHODS: We analysed OHSCAR data on deceased OHCA patients in Spain during 13 months (1/10/2013 to 31/10/2014). Variables included age, sex, estimated OHCA time, cardiopulmonary resuscitation (CPR) start time and outcome. Inclusion criteria were: age 16-60 years, witnessed OHCA, no return of spontaneous circulation (ROSC) and time interval <15min between OHCA occurrence and CPR initiation. RESULTS: Of a total 8789 cases, 3290 met the age criteria; of these, CPR was not witnessed in 745 cases. Among the remaining 2545 patients, 141 were included in uncontrolled donation after cardiac death (uDCD) programs, 902 arrived at the hospital with ROSC, 64 arrived with ongoing CPR and 15 cases were lost to follow-up. Of the remaining 1423 without ROSC, CPR initiation time was not recorded in 454 cases and 398 did not meet the time criteria <15min between OHCA and CPR initiation. Finally, 571 met all the criteria and could have been potential donors. There were significant differences in the actual donors percentage from potential donors percentage between provinces with and without donor programs (141/322=43.8% versus 0/390=0%), but there were no differences in ROSC between the two types of provinces (418/1320=31.7% versus 652/1970=33.4%). CONCLUSIONS: Many potential donors are missed in current clinical practice. uDCD programs are few and underused even in a country with high rates of organ transplantation.

Out-of-hospital cardiac arrest (OHCA) attended by mobile emergency teams with a physician on board. Results of the Spanish OHCA Registry (OSHCAR).

Most survival outcomes in out-of-hospital cardiac arrest (OHCA) are provided by emergency medical services (EMS) without a doctor on board. Our objective was to determine such outcomes in a whole country with public physician-led EMS. METHODS: We analyzed data from a nationwide prospective registry of OHCA cases attended by 19 public EMS in Spain, covering the period from 1-October 2013 to 30-October 2014. RESULTS: Advanced life support (ALS) was initiated in 9347 cases (incidence 18.6 cases/105 inhabitants per year). Resuscitation was considered futile in 558 cases (5.9%), and ALS was continued in 8789 cases (94.1%); mean age 63.5±17 years, 72.1% men. Initial rhythm was shockable in 22.1% of cases. Basic life support (BLS) was provided by bystanders in 1602 (24%) cases (635 of them with telephone assistance from the dispatch center). Of 8789 patients receiving ALS, 72.1% men, 2669 (30.4%) patients had return of spontaneous circulation on hospital arrival, 50.6% when the initial rhythm was shockable. Hospital discharge with good neurological status (CPC1-2) was found in 11.1% of the study population and in 27.6% when considering the Utstein comparator group of patients. A total of 216 (2.5%) patients arrived at the hospital with ongoing resuscitation, of whom only one survived with CPC1-2, and 165 (1.9%) patients were included in non-heart-beating donation programs. CONCLUSIONS: In Spain with physician-led EMS, OHCA survival with CPC1-2 reached a reasonable percentage despite only a modest contribution of bystander BLS. Ongoing resuscitation strategy seems to be futile except when considering non-heart beating donation programs.