BACKGROUND: Refractory out-of-hospital cardiac arrest (OHCA) has a poor outcome. In patients, who cannot be rescued despite using advanced techniques like extracorporeal cardiopulmonary resuscitation (ECPR), organ donation may be considered. This study aims to evaluate, in refractory OHCA, how ECPR versus a standard-based approach allows organ donorship. METHODS: The Prague OHCA trial randomized adults with a witnessed refractory OHCA of presumed cardiac origin to either an ECPR-based or standard approach. Patients who died of brain death or those who died of primary circulatory reasons and were not candidates for cardiac transplantation or durable ventricle assist device were evaluated as potential organ donors by a transplant center. In this post-hoc analysis, the effect on organ donation rates and one-year organ survival in recipients was examined. RESULTS: Out of 256 enrolled patients, 75 (29%) died prehospitally or within 1 hour after admission and 107 (42%) during the hospital stay. From a total of 24 considered donors, 21 and 3 (p = 0.01) were recruited from the ECPR vs standard approach arm, respectively. Fifteen brain-dead and none cardiac-dead subjects were ultimately accepted, 13 from the ECPR and two from the standard strategy group. A total of 36 organs were harvested. The organs were successfully transplanted into 34 recipients. All transplanted organs were fully functional, and none of the recipients died due to graft failure within the one-year period post-transplant. CONCLUSION: The ECPR-based approach in the refractory OHCA trial is associated with increased organ donorship and an excellent outcome of transplanted organs. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01511666. Registered January 19, 2012.

• Klíčová slova
• Extracorporeal cardiopulmonary resuscitation, Extracorporeal life support, Extracorporeal membrane oxygenation, Organ donation, Out-of-hospital cardiac arrest, Transplantation,
• MeSH
• dospělí MeSH
• kardiopulmonální resuscitace * metody   MeSH
• lidé MeSH
• mimotělní membránová oxygenace * metody   MeSH
• retrospektivní studie MeSH
• transplantace orgánů * MeSH
• zástava srdce mimo nemocnici * terapie   MeSH
• získávání tkání a orgánů * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

AIMS: Refractory out-of-hospital cardiac arrest (r-OHCA) in patients with pulmonary embolism (PE) is associated with poor outcomes. The role of extracorporeal cardiopulmonary resuscitation (ECPR) in this patient group is uncertain. This study aims to analyse clinical course, outcomes, and the effect of an invasive procedure, including ECPR, in a randomized population. METHODS AND RESULTS: A post hoc analysis of a randomized controlled trial (Prague OHCA study) was conducted to evaluate the effect of ECPR vs. a standard approach in r-OHCA. A subgroup of patients with PE-related r-OHCA was identified, and procedural and outcome characteristics, including favourable neurological survival, organ donation, and complications, were compared to patients without PE. Pulmonary embolism was identified as a cause of r-OHCA in 24 of 256 (9.4%) enrolled patients. Patients with PE were more likely to be women [12/24 (50%) vs. 32/232 (13.8%); P < 0.001] and presented more frequently with an initial non-shockable rhythm [23/24 (95.8%) vs. 77/232 (33.2%); P < 0.001], as well as more severe acidosis at admission [median pH (interquartile range); 6.83 (6.75-6.88) vs. 6.98 (6.82-7.14); P < 0.001]. Their favourable 180-day neurological survival was significantly lower [2/24 (8.3%) vs. 66/232 (28.4%); P = 0.049], but the proportion of accepted organ donors was higher (16.7 vs. 4.7%, P = 0.04). CONCLUSION: Refractory out-of-hospital cardiac arrest due to PE has a different presentation and inferior outcomes compared to other causes but may represent an important source of organ donations. The ECPR method did not improve patient outcomes.

• Klíčová slova
• cardiac arrest, extracorporeal cardiopulmonary resuscitation, organ donorship, pulmonary embolism,
• MeSH
• kardiopulmonální resuscitace * metody   MeSH
• lidé MeSH
• mimotělní membránová oxygenace * metody   MeSH
• plicní embolie * etiologie   komplikace   MeSH
• retrospektivní studie MeSH
• zástava srdce mimo nemocnici * etiologie   terapie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

The authors analyze the development and creation of the concept of a uniformly organized blood transfusion service in the CSSR from its beginning to the present time. For the needs of the Czechoslovak socialist health services it proved expedient to integrate haemotherapeutic care in a common department of haematology and transfusiology, in a network of common sections of haematology and blood transfusion and to focus the transfusion service on clinical work. On average there is one common department for a population of 135,000 which ensures blood transfusions as well as haematological work and there is one doctor specialized in haematology and transfusiology per 48,000 population. Blood donorship in the CSSR for basic needs of the transfusion service is not paid; it is organized by the Czechoslovak Red Cross. On average 35,000 units of blood per 1 million inhabitants are collected per year. Component haemotherapy predominates; only 20-25% of the production is used for transfusions of whole blood. The ratio of whole blood transfusions to erythrocytes is 35:65%. The annual number of blood transfusions per hospital bed is 5 on average. The incidence of undesirable posttransfusion reactions, mainly febrile and allergic, is low, it varies between 0.2 and 0.4%. Serious haemolytic reactions are rare and occur in recent years in one patient per 100,000 transfusions. The achievement of the standard of the Czechoslovak blood transfusion service is due to the care of the two national ministries of health, the good training of workers and the clinical orientation of the performed work.

• MeSH
• dějiny 20. století MeSH
• krevní transfuze dějiny   MeSH
• lidé MeSH
• Check Tag
• dějiny 20. století MeSH
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• historické články MeSH
• Geografické názvy
• Československo MeSH