ORIGINAL ARTICLE

Mechanical cardiopump use in organ donation

after prehospital cardiac death
ALONSO A. MATEOS RODRÍGUEZ1, JOSÉ MARÍA NAVALPOTRO PASCUAL1,
MARÍA EUGENIA MARTÍN MALDONADO2, CALOS BARBA ALONSO2, LUIS PARDILLOS FERRER1,
AMADO ANDRÉS BELMONTE3
Comisión de Investigación SUMMA112. 2Médico SUMMA112. 3Coordinador de Trasplantes, Hospital 12 de
1

Octubre. Madrid, Spain.

CORRESPONDENCE:
Dr. Alonso A. Mateos Rodríguez
Servicio de Urgencia Médica
de Madrid (SUMMA112)
Comisión de Investigación.
C/ Antracita, 2 bis
28045 Madrid, Spain
E-mail: aamateosr@gmail.com
amateo.summa@salud.madrid.org
RECEIVED:
30-4-2010
ACCEPTED:
21-6-2010
CONFLICT OF INTEREST:
None
Objective: The SUMMA112 emergency health service of Madrid is working with area
hospitals on a program to facilitate organ donation from persons who have suffered
cardiac death outside the hospital and who have not responded to resuscitation
maneuvers. The aim of this study was to assess the usefulness of mechanical
cardiopumps.
Methods: Retrospective, descriptive study based on SUMMA112 data available for organ
donors after cardiac death. The data analyzed were from 2008, before cardiopumps, and
2009, the year when cardiopumps became widely used. Two models were available; one
was the LUCAS pump, from Physio-Control, and the other was the Autopulse, from Zoll.
Independent variables studied were age, sex, cardiopump use and model, time from
arrival at the emergency site until notification of arrival at the hospital. Dependent
variables were categorization as a valid donor, number of organs donated, and types of
organs donated. We compared the mean number of organs donated in 2008 (period
without mechanical cardiopumps) to the number donated in 2009 (with cardiopumps).
Results: A total of 108 cases were on record. Eighty-seven percent of the patients were
men. The median (interquartile range) age was 40 (35-49.75) years. Overall, 82 cadavers
were valid donors and a mean of 3.18 organs per donor were obtained. In the period
without cardiopumps, the mean number of organs obtained was 3.4; with cardiopumps
the mean was 2.9 organs (P<0.05). There were no significant differences between the 2
cardiopumps.
Conclusion: Fewer organs per donor were extracted and transplanted in the year the
mechanical cardiopumps were used. Further studies are needed to demonstrate whether
or not these devices can increase the number or quality of extracted organs.
[Emergencias 2010;22:264-268]

Key words: Emergency medical services. Organ donation after cardiac death.
Mechanical cardiopump.

Inroduction compressed air or oxygen, raises and lowers it

In recent years a series of mechanical devices
have been developed to replace manual cardiac
massage in cases of sudden cardiac arrest (SCA).
These devices have been shown to improve
the quality of CPR1 and in some cases improve
short-term survival 2,3 . There are two devices
currently in use: the LUCAS © Physio-Control
(Lucas) and the AUTOPULSE© by Zoll (AU-
TOPULSE). The Lucas uses a piston system with
a suction cup that attaches to the chest of the
patient at a particular point and, activated by
(Figure 1).The AUTOPULSE also exerts a similar
force on the chest, but does so through a load
distributing life band that "embraces" the pa-
tient's trunk, powered by rechargeable batter-
ies (Figure 2). Both devices offer the possibility
of performing either 30:2 or continuous com-
pression, and offer the additional advantage of
freeing one of the professionals involved in the
resuscitation for other tasks. Both devices have
shown a low incidence of chest injuries, or at
least no higher than that associated with ma-
nual massage4.

264 Emergencias 2010; 22: 264-268

 MECHANICAL CARDIOPUMP USE IN ORGAN DONATION AFTER PREHOSPITAL CARDIAC DEATH

Figure 1. LUCAS® (Physiol-Control).

Figure 2. Autopulse® (Zoll).

Donation after cardiac death (DMC in Spanish)
is a protocol that involves an additional effort for
the team attending the emergency, as intermit-
tent chest compression must be maintained from
the moment of contact with the SCA patient until
determining his/her death and starting the
process of cannulation for extracorporeal circula-
tion. Since the inception of the DMC program,
these devices have been available but only occa-
sionally used. A medical helicopter carried an Au-
topulse, and a Lucas device was shared by ICU-
equipped ambulances.
Since the beginning of 2009, generalized use
of these devices became standard for all cases of
SCA attended by the Emergency Medical Service
of Madrid (SUMMA112) on the creation of a mo-
bile unit that transported the device to the scene
of the emergency. This represented an advance in
patient care and an improvement in the quality of
cardiopulmonary resuscitation (CPR) and de-
creased workload for the attending team. It also
improved the transfer of potential donor patients
to hospitals, minimizing the risk of work-related
injury by avoiding the need for a team member
to perform cardiac massage in a moving vehicle.
The aim of this study was to describe the re-
sults of the DMC program after the widespread
introduction of mechanical cardio-pumps and
compare them with data collected before the use
of such devices. In addition, we wished to com-
pare the performance of both types of device.
Method
SUMMA112 has created a database of patients
transferred as potential donors that includes the
following items: referral hospital, patient age and
sex, time to arrival at the scene, time to arrival at
the hospital, cause of SCA, effective organ dona-
tion or not, number and type of organs donated
and reason for non-donation if applicable (infor-
mation provided by hospitals) use of mechanic
cardio-pump (MCP) and use of medical helicop-
ter. This database is used in various research stud-
ies and the information is shared by the two hos-

Emergencias 2010; 22: 264-268 265

A. Mateos Rodríguez et al.

Table 1. Study Population Data

Period WithoutMCP With MCP p
(n = 46) (n = 62)
Age in years (mean, SD) 40 (10.6) 40 (10) ns
Sex male (n,%) 42 (91.3) 52 (83,9) ns
Weather Alert - arrival at the scene (median, IQR) 13’17’’ (10’55’’-18’00’’) 11’30’’ (7’59’’-14’00’’) ns
Weather Alert - hospital arrival (median, IQR) 88’51’’ (71’30’’-114’15’’) 73’20’’ (57’22’’-92’50’’) ns
Donors valid (n,%) 36 (78) 46 (74) ns
MCP: Mechanical cardiopump, SD: standard deviation, ns: not significant, IQR: interquartile range.

pitals receiving potential donors: Hospital Clínico Table 2. Causes of non-donation

San Carlos and Hospital 12 Octubre, in Madrid. Period Without MCP With MCP
The criterion for using one or the other type of (n = 10) (n = 16)
device was availability. The medical helicopter on- Pump failure (extracorporeal circulation
ly carries an AUTOPULSE. Ambulances had both failure) 3 1
Family refusal 1 3
devices available for the first half of 2009 and on- Judicial Refusal 0 1
ly Lucas during the second half. Patient’s will 0 2
This study is based on the collection of all da- Biological causes (time limit exceeded,
Positive serology, active cancer, etc.) 6 9
ta for the years 2008 and 2009. The cardiopumps
MCP: Mechanical cardiopump.
were not used in 2008, coming into operation in
2009. Thus we created two different groups from
the DMC program data: one without the use of (24%), without differences between the two
MCP and the other with such use. groups. The reasons for non-donation are listed in
Statistical analysis was performed with the soft- Table 2.
ware Statistical Package for Social Sciences, Statis- The organs harvested and transplanted were
tical SPSS © 15.0. Quantitative variables are ex- as follows: 136 kidneys, 35 livers, 51 corneas, 7
pressed as means (and standard deviation) or lungs and 32 samples of bone tissue (Table 3).
median [Interquartile range (IQR), 25-75 per- The mean number of organs harvested per valid
centile] according to whether their distributions donor was 2.9 in period 2 with MCPand 3.4 in
were normal or not. Qualitative variables are ex- the earlier period 1 without MCP (p < 0.05). With
pressed as percentages. regard to the type of cardio-pump used, we
To study the association between qualitative found no significant differences in the number of
variables, we used χ 2 test or Fisher exact test. organs obtained (Lucas 2.9; AUTOPULSE 3.4, as
Mean quantitative variable differences were com- shown in Table 4).
pared using Student's t test under the assumption
of normality.
Discussion

Results The results obtained in our series show that

We analysed data relating to a total of 108 pa-
tients, 46 from the period before MCP use (period
1) and 62 from the period with MCP (period 2).
Overall, 87% of cases were male and the median
(IQR) age was 40 (35-49.7) years. The median
(IQR) time to arrival at the scene was 12 minutes
9 seconds (7:50 to 13:54). The median (IQR) time
from the alert to arrival at hospital was 80 minu-
tes (57-93). There were 36 valid organ donors
from period 1 and 46 in period 2 (with MCP), to-
talling 82 (75%) valid donors. The mean number
of valid organs harvested was 3.18 with a median
of three organs per donor. Baseline characteristics
of the study population were similar for both
groups (see Table 1).
The total number of non-valid donors was 26
sudden cardiac death donors receiving MCP pro-
vided fewer organs than those not receiving MCP.
The reasons for this difference are difficult to ex-
plain. A similar study by the Emergency Services
of Barcelona concluded that the Lucas device is as
effective as manual cardiac massage, but also
showed that the rate of discarded kidneys due to
renal malperfusion was higher in the group re-
ceiving MCP5.
Despite our results and the lower number of
organs harvested from patients receiving MCP,
the array of variables involved in determining or-
gan viability makes it almost difficult to establish a
causal relationship between cardiopump use and
the harvest of more or fewer organs for donation.
The main limitation of our study is the low num-
ber of cases and the methodological approach

266 Emergencias 2010; 22: 264-268

 MECHANICAL CARDIOPUMP USE IN ORGAN DONATION AFTER PREHOSPITAL CARDIAC DEATH

Table 3. Organs donated

Period Total Without MCP With MCP p
Nº valid donors 82 36 46 ns
Kidneys (obtained/possible) 136/164 65/72 71/92 < 0.05
Liver [n (mean, SD)] 35 (0.43[0.49]) 16 (0.44[0.50]) 19 (0.41[0.49]) ns
Corneal tissue [n (mean SD)] 51 (0.62[0.48]) 25 (0.69[0.46]) 26 (0.57[0.50]) ns
Bone tissue [n (mean, SD)] 32 (0.39[0.49]) 14 (0.39[0.49]) 18(0.39[0.49]) ns
Lung [n (mean, SD)] 7 (0.09[0.32]) 4 (0.11[0.31]) 3 (0.07[0.32]) ns
Average number of donor organs by valid (mean, SD) 3.18 (1.15) 3.4 (1.8) 2.9 (1.2) < 0.05
MCP: Mechanical cardiopump, ns: not significant.

Table 4. Organs donated according to type of MCP

Total Lucas Autopulse Undetermined p*
Number of cases 46 30 10 6 ns
Kidneys (obtained/possible) 71/92 48/60 15/20 8/12 ns
Liver (n, mean) 19 (0.4) 13 (0.4) 5 (0.5) 1 (0.1) ns
Corneal tissue (n, mean) 26 (0.5) 15 (0.5) 7 (0.7) 4 (0.6) ns
Bone (n, mean) 18 (0.3) 12 (0.4) 5 (0.5) 1 (0.1) ns
Lung (n, mean) 3 (0.06) 1 (0.03) 2 (0.2) 0 ns
TOTAL (n, mean) 137 (2.9) 89 (2.9) 34 (3.4) 14 (2.6) ns
*The p value was calculated for differences between the AUTOPULSE and Lucas groups; ns: not significant.

with case series which makes it impossible to find
causal relationships and even less so with the use
of mechanical devices. But even considering these
methodological limitations, the statistically signifi-
cant difference between the two groups is surpris-
ing. Further studies with more variables are need-
ed to determine the role of MCP in the DMC
program.
From inception of the MCP period, time to ar-
rival on the scene reduced by almost 90 seconds
and time to arrival at the hospital decreased by
14 minutes. The former reduction cannot be at-
tributed to the use or non-use of these devices,
but rather to improvement in the response to the
SCA. The decrease in time to arrival at the hospi-
tal may be due to the use of these devices be-
cause they facilitate mobilization of the patient.
Their use frees one of the team members from
the task of external manual cardiac massage and
facilitates ambulance transfer to hospital, without
the need for a person at the bedside continuously
performing chest compressions.
A previous study by our group has shown very
low rates of primary renal failure in a number of
kidneys transplanted from cardiopump deceased
donors - only two kidneys transplanted in 20096.
This figure is similar to that reported in a case se-
ries without the use of MCP7.
On comparing the mean numbers and types
of organs harvested per donor between the two
models of cardiopumps used in this study, we
found no significant differences, but it should be
noted that the number of cases treated was too
low, especially with AUTOPULSE, to be able to
statistically distinguish between the two types.
More data are needed to reach a satisfactory con-
clusion.
In conclusion, in this case series study of po-
tential donors, fewer organs were harvested from
deceased SCA patients transferred to hospital un-
der MCP than when transferred receiving manual
cardiac massage.
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Emergencias 2010; 22: 264-268 267

A. Mateos Rodríguez et al.

Aplicación de cardiocompresores mecánicos en el donante tras una muerte cardiaca

extrahospitalaria
Mateos Rodríguez AA, Navalpotro Pascual MJ, Martín Maldonado ME, Barba Alonso C, Pardillos Ferrer L,
Andrés Belmonte A
Objetivo: El Servicio de Urgencias Médicas de Madrid SUMMA112, en colaboración con dos hospitales de Madrid, es-
tá inmerso en un programa de donación de órganos de pacientes que han sufrido una parada cardiaca extrahospitala-
ria y no han respondido a las maniobras de resucitación. El objetivo de este estudio es valorar los resultados de la apli-
cación de cardiocompresores mecánicos.
Metodología: Estudio descriptivo retrospectivo basado en la base de datos del SUMMA112 de donantes tras muerte
cardiaca. El estudio se realizó durante el año 2008 y 2009, año este último en el que se generalizó el uso de estos car-
diocompresores. Se usaron dos cardiocompresores, el LUCAS© de Physio-Control y el Autopulse© de Zoll. Se estudiaron
como variables independientes la edad, el sexo, el uso de cardiocompresión mecánica (CCM) y el tipo de cardiocom-
presor, el tiempo de llegada a la escena y el tiempo desde la alerta a la llegada al hospital. Como variables dependien-
tes se registraron si fueron donantes válidos, número de órganos y tipo de órganos. Se compararon los resultados de
media por donantes en el año 2008 (periodo sin CCM) y 2009 (periodo con CCM).
Resultados: Se registraron un total de 108 casos. El 87% del total de pacientes eran varones, y la mediana (RIQ) de la
edad era 40 años (35-49,7). Se obtuvieron un total de 82 donantes válidos, lo que corresponde a 3,18 órganos por
donante. La media de órganos en el periodo sin CCM fue de 3,4 y en el de CCM de 2,9 (p < 0,05). No encontramos
diferencia significativa en la comparación entre los dos cardiocompresores.
Conclusión: Según nuestra serie, el número de órganos extraídos y trasplantados por donante es menor con CCM. Se
necesitan más estudios para demostrar que estos dispositivos mejoran el número o la calidad de los órganos extraídos.
[Emergencias 2010;22:264-268]

Palabras clave: Servicios médicos de emergencia. Donante tras muerte cardiaca. Cardiocompresor mecánico.

268 Emergencias 2010; 22: 264-268