(679) Brain Death and Organ Donation in Post-Cardiac Arrest Patients Treated With TTM in South Korea

Introduction: The occurrence of brain death (BD) in patients with hypoxic-ischemic brain injury in post cardiac arrest patients creates opportunities for organ donation. We aimed to determine risk factors for evolution toward BD after OHCA.

Methods: We analyzed all consecutive OHCA patients treated with TTM admitted to 12 medical centers at urban academic hospitals from October 2015 to December 2018. Survival and neurological outcomes (Glasgow–Pittsburgh Cerebral Performance Categories, CPC) were assessed at discharge. Good neurological outcome was defined as a CPC 1 or 2. BD was defined according to international guidelines. As recommended, BD was clinically diagnosed in the absence of confounding factors. Electroencephalogram was performed to confirm BD after complete TTM.

Results: A total 907 OHCA patients who were treated TTM were included in this study. Among these, 271 (29.9%) had good neurological outcomes, whereas 130 (14.3%) evolved toward BD. 61 (46.9%) of BD patients were performed organ donation. Independent risk factors for BD were age (OR 0.98 (0.97-1.00)), not-witnessed (OR 1.68 (1.05-2.67)), time from collapse to ROSC (OR 1.01 (1.00-1.02)), non-cardiac etiology (OR 2.76 (1.72-4.46)), no motor response (OR 2.48 (1.01-7.43)) and no PLR immediate after ROSC (OR 2.37 (1.19-5.19)). There were no differences in induction time, overcooling, cardiovascular score or 1st day fluid balance.

Conclusions: These findings might help physicians in their decision-making processes and could serve as a basis for developing a simple score that could accurately predict BD after OHCA treated with TTM. The early identification of a patient with BD might motivate teams to optimize organ protection in the prospect of organ donation rather than only considering withdrawal of life support.