Impact of Prolonged Cardiopulmonary Resuscitation on Cardiac Allograft Quality and Recipient Outcomes

K. Grace. Phillips¹, P. Parhami², L. James³, D. Smith⁴, A. Galloway⁵, E. Grossi⁶, N. Moazami^4
1NYU Langone, New York, New York ²NYU Langone Hospital, New York, New York ³New York University, New York, New York ⁴NYU Langone Medical Center, New York, New York ⁵NYU Grossman School of Medicine, New York, New York ⁶New York University Medical Center, New York, New York

Purpose: The impact of cardiopulmonary resuscitation (CPR), particularly prolonged CPR or unknown cardiac downtime, on the quality of cardiac allografts and recipient outcomes remains uncertain. This retrospective study aimed to investigate the effect of prolonged CPR in organ donors on cardiac allograft quality and recipient survival.

Methods: A review of adult heart transplantations reported in the United Network for Organ Sharing database from 2012-2022 was conducted. The donor population stratification was based on CPR status: a propensity-matched analysis was performed comparing donors who received prolonged (> 45 minutes)( CPR+) to those who did not receive (CPR-). An additional propensity matched analysis of donors with an unknown downtime was performed. Survival analysis was conducted using Kaplan-Meier analysis and log-rank tests, and Cox multivariate regression was employed to identify independent predictors of survival.

Results: The incidence of donors who received CPR has doubled over the past decade, with 60.9% of all donors having undergone CPR in 2022 compared to 26.8% in 2012. After propensity matching, prolonged CPR+ donors were found to have a higher prevalence of obesity, elevated creatinine levels, CDC “high-risk” designation, and hepatitis C (HCV) infection while they were less likely to be on inotropic agents or vasopressin. Recipients of cardiac allografts from prolonged CPR donors had significantly shorter waiting list durations (59 days vs. 227 days, p< 0.001). There was no significant difference in recipient survival on Kaplan-Meier analysis.

Conclusion: The incidence of cardiac allografts from donors who underwent CPR has increased over the past decade, with drug overdose donors representing a substantial proportion of the increase. After propensity matching, recipients of cardiac allografts from donors who received prolonged CPR did not experience significant differences in patient or graft survival compared to those who did not receive CPR.

Identify the source of the funding for this research project: There were no sources of funding for this project.