Extracorporeal Membrane Oxygenation (ECMO) in the context of cardiac arrest: a systematic review evaluating the potential impact in organ donation

Abstract

Aim: The shortage of organs is appointed as the most challenging problem regarding transplantation. Extracorporeal membrane oxygenation (ECMO) is increasingly used for mechanical circulatory support in refractory cardiac arrest (ECPR), as well as for organ preservation in uncontrolled (uDCD) and controlled donation after circulatory death (cDCD). In the present study, we assessed the impact of ECMO in organ donation. Methods: We searched three electronic databases targeting studies with ECMO and organ donation: single arm (with ECMO as intervention) and comparative (comparing ECMO with other organ preservation techniques) studies were included. When possible, the organ use rate and summary measures related to graft function were assessed. Quality assessment of studies was also performed. Results: We included 58 primary observational studies, of which 14 were comparative. The number of included studies increased over time. The most common clinical scenario was cDCD (n=37), followed by uDCD (n=23), and donation after brain death (DBD) in ECPR (n=4). Multiorgan donation was more frequent in DBD in ECPR (75%), followed by cDCD (43%) and uDCD (21%). The organ use rate was assessed in 11 comparative studies, and in 8 cases proven superior when ECMO was compared with other organ preservation techniques (0.72-2.62 vs. 0.66-2.00). The quality of the included studies was considered "good" in 34, "fair" in 5, and "poor" in 19. Conclusion: The use of ECMO is increasing and positively impacts organ donation. Controlled and uncontrolled DCD represent the main clinical scenarios and the use of ECMO is associated with a higher organ use rate.