1
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Rajsic S, Treml B, Innerhofer N, Eckhardt C, Radovanovic Spurnic A, Breitkopf R. Organ Donation from Patients Receiving Extracorporeal Membrane Oxygenation: A Systematic Review. J Cardiothorac Vasc Anesth 2024; 38:1531-1538. [PMID: 38643059 DOI: 10.1053/j.jvca.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/01/2024] [Accepted: 03/17/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVE The mismatch between the demand for and supply of organs for transplantation is steadily growing. Various strategies have been incorporated to improve the availability of organs, including organ use from patients receiving extracorporeal membrane oxygenation (ECMO) at the time of death. However, there is no systematic evidence of the outcome of grafts from these donors. DESIGN Systematic literature review (Scopus and PubMed, up to October 11, 2023). SETTING All study designs. PARTICIPANTS Organ recipients from patients on ECMO at the time of death. INTERVENTION Outcome of organ donation from ECMO donors. MEASUREMENTS AND MAIN RESULTS The search yielded 1,692 publications, with 20 studies ultimately included, comprising 147 donors and 360 organ donations. The most frequently donated organs were kidneys (68%, 244/360), followed by liver (24%, 85/360). In total, 98% (292/299) of recipients survived with a preserved graft function (92%, 319/347) until follow-up within a variable period of up to 3 years. CONCLUSION Organ transplantation from donors supported with ECMO at the time of death shows high graft and recipient survival. ECMO could be a suitable approach for expanding the donor pool, helping to alleviate the worldwide organ shortage.
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Affiliation(s)
- Sasa Rajsic
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria.
| | - Benedikt Treml
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Nicole Innerhofer
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Christine Eckhardt
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | | | - Robert Breitkopf
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
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2
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Copeland H, Knezevic I, Baran DA, Rao V, Pham M, Gustafsson F, Pinney S, Lima B, Masetti M, Ciarka A, Rajagopalan N, Torres A, Hsich E, Patel JK, Goldraich LA, Colvin M, Segovia J, Ross H, Ginwalla M, Sharif-Kashani B, Farr MA, Potena L, Kobashigawa J, Crespo-Leiro MG, Altman N, Wagner F, Cook J, Stosor V, Grossi PA, Khush K, Yagdi T, Restaino S, Tsui S, Absi D, Sokos G, Zuckermann A, Wayda B, Felius J, Hall SA. Donor heart selection: Evidence-based guidelines for providers. J Heart Lung Transplant 2023; 42:7-29. [PMID: 36357275 PMCID: PMC10284152 DOI: 10.1016/j.healun.2022.08.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 01/31/2023] Open
Abstract
The proposed donor heart selection guidelines provide evidence-based and expert-consensus recommendations for the selection of donor hearts following brain death. These recommendations were compiled by an international panel of experts based on an extensive literature review.
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Affiliation(s)
- Hannah Copeland
- Department of Cardiovascular and Thoracic Surgery Lutheran Hospital, Fort Wayne, Indiana; Indiana University School of Medicine-Fort Wayne, Fort Wayne, Indiana.
| | - Ivan Knezevic
- Transplantation Centre, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - David A Baran
- Department of Medicine, Division of Cardiology, Sentara Heart Hospital, Norfolk, Virginia
| | - Vivek Rao
- Peter Munk Cardiac Centre Toronto General Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Michael Pham
- Sutter Health California Pacific Medical Center, San Francisco, California
| | - Finn Gustafsson
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sean Pinney
- University of Chicago Medicine, Chicago, Illinois
| | - Brian Lima
- Medical City Heart Hospital, Dallas, Texas
| | - Marco Masetti
- Heart Failure and Heart Transplant Unit IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Agnieszka Ciarka
- Department of Cardiovascular Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; Institute of Civilisation Diseases and Regenerative Medicine, University of Information Technology and Management, Rzeszow, Poland
| | | | - Adriana Torres
- Los Cobos Medical Center, Universidad El Bosque, Bogota, Colombia
| | | | | | | | | | - Javier Segovia
- Cardiology Department, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Madrid, Spain
| | - Heather Ross
- University of Toronto, Toronto, Ontario, Canada; Sutter Health California Pacific Medical Center, San Francisco, California
| | - Mahazarin Ginwalla
- Cardiovascular Division, Palo Alto Medical Foundation/Sutter Health, Burlingame, California
| | - Babak Sharif-Kashani
- Department of Cardiology, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - MaryJane A Farr
- Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Luciano Potena
- Heart Failure and Heart Transplant Unit IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | | | | | | | | | | | - Valentina Stosor
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Kiran Khush
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Tahir Yagdi
- Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey
| | - Susan Restaino
- Division of Cardiology Columbia University, New York, New York; New York Presbyterian Hospital, New York, New York
| | - Steven Tsui
- Department of Cardiothoracic Surgery Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Daniel Absi
- Department of Cardiothoracic and Transplant Surgery, University Hospital Favaloro Foundation, Buenos Aires, Argentina
| | - George Sokos
- Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Brian Wayda
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Joost Felius
- Baylor Scott & White Research Institute, Dallas, Texas; Texas A&M University Health Science Center, Dallas, Texas
| | - Shelley A Hall
- Texas A&M University Health Science Center, Dallas, Texas; Division of Transplant Cardiology, Mechanical Circulatory Support and Advanced Heart Failure, Baylor University Medical Center, Dallas, Texas
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3
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Stadlerová B, Černá Pařízková R, Škola J, Škulec R, Pokorná E, Šustek P, Prudil L, Černý V. VV‑ECMO in organ donor after brain death - case report and review of the issue. ANESTEZIOLOGIE A INTENZIVNÍ MEDICÍNA 2022. [DOI: 10.36290/aim.2022.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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4
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Abstract
Cardiac transplantation is considered the gold-standard treatment option for patients suffering from end-stage heart failure refractory to maximum medical therapy. A major determinant of graft function and recipient survival is a comprehensive evaluation of the donor allograft. Challenges arise when designing and implementing an evidence-based donor evaluation protocol due to the number of influential donor-specific characteristics and the complex interactions that occur between them. Here, we present our systematic approach to donor evaluation by examining the impact that relevant donor variables have on graft function and recipient outcomes.
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Affiliation(s)
- Robert Tatum
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, 1025 Walnut St, Suite 607, Philadelphia, PA 19107 USA
| | - Alexandros Briasoulis
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, 20 Hawkins Drive E318, Iowa City, IA 52242 USA
| | - Vakhtang Tchantchaleishvili
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, 1025 Walnut St, Suite 607, Philadelphia, PA 19107 USA
| | - H. Todd Massey
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, 1025 Walnut St, Suite 607, Philadelphia, PA 19107 USA
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5
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Peetz A, Kuzemchak M, Hammack C, Guillamondegui OD, Dennis BM, Eastham S, Meador K, Beskow L, Patel M. Trauma Surgeons' Perceptions of Resuscitating Lethally Injured Patients for Organ Preservation. Am Surg 2021; 88:663-667. [PMID: 34962834 DOI: 10.1177/00031348211065100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Trauma surgeons face a challenge when deciding whether to resuscitate lethally injured patients whose organ donor status is unknown. Data suggests practice pattern variability in this setting, but little is known about why. MATERIALS AND METHODS We conducted semi-structured interviews with trauma surgeons practicing in Level 1 or 2 trauma centers in Tennessee. Interviews focused on ethical dilemmas and resource constraints. Analysis was performed using inductive thematic analysis. RESULTS Response rate was 73% (11/15). Four key themes emerged. All described resuscitating patients to buy time to collect more definitive clinical information and to identify family. Some acknowledged this served the secondary purpose of organ preservation. 11/11 participants felt a primacy of obligation to the patient in front of them even after it became apparent, they could not personally benefit. For 9/11 (82%), the moral obligation to consider organ preservation was secondary/balancing; 2/11 (18%) felt it was irrelevant/immoral. Resource allocation was commonly considered. All participants expressed some limitation to resources they would allocate. All participants conveyed clear moral agency in determining resuscitation extent when the goal was to save the patient's life, however this was less clear when resuscitating for organ preservation. Across themes, perceptions of a "standard practice" existed but the described practices were not consistent across interviewees. DISCUSSION Widely ranging perceptions regarding ethical and resource considerations underlie practices resuscitating toward organ preservation. Common themes suggest a lack of consensus. Despite expressed beliefs, there is no identifiable standard of practice amongst trauma surgeons resuscitating in this setting.
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Affiliation(s)
- Allan Peetz
- Section of Surgical Sciences, Department of General Surgery, 6339Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Biomedical Ethics and Society, 171882Vanderbilt University Medical Center, Nashville, TN, USA.,12327Vanderbilt University School of Medicine, Nashville, TN, USA.,Division of Trauma and Surgical Critical Care, 12328Vanderbilt University Medical Center, Nashville, TN, USA.,Surgical Services, 20106Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Marie Kuzemchak
- Section of Surgical Sciences, Department of General Surgery, 6339Vanderbilt University Medical Center, Nashville, TN, USA
| | - Catherine Hammack
- Center for Biomedical Ethics and Society, 171882Vanderbilt University Medical Center, Nashville, TN, USA
| | - Oscar D Guillamondegui
- Section of Surgical Sciences, Department of General Surgery, 6339Vanderbilt University Medical Center, Nashville, TN, USA.,12327Vanderbilt University School of Medicine, Nashville, TN, USA.,Division of Trauma and Surgical Critical Care, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bradley M Dennis
- Section of Surgical Sciences, Department of General Surgery, 6339Vanderbilt University Medical Center, Nashville, TN, USA.,12327Vanderbilt University School of Medicine, Nashville, TN, USA.,Division of Trauma and Surgical Critical Care, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shannon Eastham
- Section of Surgical Sciences, Department of General Surgery, 6339Vanderbilt University Medical Center, Nashville, TN, USA.,12327Vanderbilt University School of Medicine, Nashville, TN, USA.,Division of Trauma and Surgical Critical Care, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Keith Meador
- Center for Biomedical Ethics and Society, 171882Vanderbilt University Medical Center, Nashville, TN, USA.,12327Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Psychiatry and Behavior Sciences, 6339Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laura Beskow
- Center for Biomedical Ethics and Society, 171882Vanderbilt University Medical Center, Nashville, TN, USA.,12327Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Health Policy, 6339Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mayur Patel
- Section of Surgical Sciences, Department of General Surgery, 6339Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Biomedical Ethics and Society, 171882Vanderbilt University Medical Center, Nashville, TN, USA.,12327Vanderbilt University School of Medicine, Nashville, TN, USA.,Division of Trauma and Surgical Critical Care, 12328Vanderbilt University Medical Center, Nashville, TN, USA.,Surgical Services, 20106Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA.,Center for Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, 213918Vanderbilt Center for Health Services Research, Nashville, TN, USA
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6
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Sady ERR, Junqueira L, Veiga VC, Rojas SSO. Apnea test for brain death diagnosis in adults on extracorporeal membrane oxygenation: a review. Rev Bras Ter Intensiva 2020; 32:312-318. [PMID: 32667442 PMCID: PMC7405745 DOI: 10.5935/0103-507x.20200048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/28/2020] [Indexed: 12/05/2022] Open
Abstract
Among the potential complications of extracorporeal membrane oxygenation, neurological dysfunctions, including brain death, are not negligible. In Brazil, the diagnostic process of brain death is regulated by Federal Council of Medicine resolution 2,173 of 2017. Diagnostic tests for brain death include the apnea test, which assesses the presence of a ventilatory response to hypercapnic stimulus. However, gas exchange, including carbon dioxide removal, is maintained under extracorporeal membrane oxygenation, making the test challenging. In addition to the fact that the aforementioned resolution does not consider the specificities of the diagnostic process under extracorporeal membrane oxygenation, studies on the subject are scarce. This review aims to identify case studies (and/or case series) published in the PubMed® and Cochrane databases describing the process of brain death diagnosis. A total of 17 publications (2011 - 2019) were identified. The practical strategies described were to provide pretest supplemental oxygenation via mechanical ventilation and extracorporeal membrane oxygenation (fraction of inspired oxygen = 1.0) and, at the beginning of the test, titrate the sweep flow (0.5 - 1.0L/minute) to minimize carbon dioxide removal. It is also recommended to increase blood flow and/or sweep flow in the presence of hypoxemia and/or hypotension, which may be combined with fluid infusion and/or the escalation of inotropic/vasoactive drugs. If the partial pressure of carbon dioxide threshold is not reached, repeating the test under supplementation of carbon dioxide exogenous to the circuit is an alternative. Last, in cases of venoarterial extracorporeal membrane oxygenation, to measure gas variation and exclude differential hypoxia, blood samples of the native and extracorporeal (post-oxygenator) circulations are recommended.
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Affiliation(s)
| | - Lígia Junqueira
- Unidade de Terapia Intensiva Neurológica, Hospital Beneficência Portuguesa - São Paulo (SP), Brasil
| | - Viviane Cordeiro Veiga
- Unidade de Terapia Intensiva Neurológica, Hospital Beneficência Portuguesa - São Paulo (SP), Brasil
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7
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Migdady I, Stephens RS, Price C, Geocadin RG, Whitman G, Cho SM. The use of apnea test and brain death determination in patients on extracorporeal membrane oxygenation: A systematic review. J Thorac Cardiovasc Surg 2020; 162:867-877.e1. [PMID: 32312535 DOI: 10.1016/j.jtcvs.2020.03.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To review practices of brain death (BD) determination in patients on extracorporeal membrane oxygenation (ECMO). METHODS A systematic search was applied to PubMed and 6 electronic databases from inception to May 22, 2019. Studies reporting methods of BD assessment in adult patients (>18 years old) while on ECMO were included, after which data regarding BD assessment were extracted. RESULTS Twenty-two studies (n = 177 patients) met the inclusion criteria. Eighty-eight patients (50%) in 19 studies underwent the apnea test (AT); most commonly through decreasing the ECMO sweep flow in 14 studies (n = 42, 48%), followed by providing CO2 through the ventilator in 2 studies (n = 6, 7%), and providing CO2 through the ECMO oxygenator in 1 study (n = 1, 1%). The details of the AT were not reported in 2 studies (n = 39, 44%). In 19 patients (22%), the AT was nonconfirmatory due to hemodynamic instability, hypoxia, insufficient CO2 rise, or unreliability of the AT. A total of 157 ancillary tests were performed, including electroencephalogram (62%), computed tomography angiography (22%), transcranial Doppler ultrasound (6%), cerebral blood flow nuclear study (5%), cerebral angiography (4%), and other (1%). Forty-seven patients (53% of patients with AT) with confirmatory AT still underwent additional ancillary for BD confirmation. Only 21 patients (12% of all patients) were declared brain-dead using confirmatory ATs alone without ancillary testing. CONCLUSIONS Performing AT for patients with ECMO was associated with high failure rate and hemodynamic complications. Our study highlights the variability in practice in regard to the AT and supports the use of ancillary tests to determine BD in patients on ECMO.
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Affiliation(s)
- Ibrahim Migdady
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Robert Scott Stephens
- Medical Intensive Care, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Carrie Price
- Welch Medical Library, Johns Hopkins University, Baltimore, Md
| | - Romergryko G Geocadin
- Departments of Neurology, Neurological Intensive Care, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Glenn Whitman
- Cardiovascular Surgical Intensive Care, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Sung-Min Cho
- Departments of Neurology, Neurological Intensive Care, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
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8
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A Protocol that Mandates Postoxygenator and Arterial Blood Gases to Confirm Brain Death on Venoarterial Extracorporeal Membrane Oxygenation. ASAIO J 2020; 66:e23-e28. [DOI: 10.1097/mat.0000000000001086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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9
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Xu L, Liang Y, Liao Y, Rong J, Xu G, Tang W. The Challenges of Apnea Tests in the Determination of Brain Death in Child Patient on Extracorporeal Membrane Oxygenation. Front Pediatr 2020; 8:358. [PMID: 32733825 PMCID: PMC7359818 DOI: 10.3389/fped.2020.00358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 05/28/2020] [Indexed: 11/13/2022] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is a life-support modality used in patients with refractory cardiac and/or respiratory failure. ECMO is linked with high risk of neurological complications including brain death. Neurological monitoring during ECMO is important for identifying patients who are suspected of brain death and allows to discontinue ineffective medical treatments. Brain death (BD) is an irreversible cessation of functions of the entire brain, containing the brainstem. The apnea test (AT) is an essential part in the clinical determination of brain death. An apnea test is by neurologic criteria compulsory to confirm BD in China. Apnea test remains a problem for patients receiving ECMO. Currently, there are not any consensus guidelines for the safe performance of AT during ECMO. We report the case of a child on venous-arterial ECMO post-cardiac arrest in whom we performed an apnea test to determine death by neurologic criteria. Decreasing sweep gas flow rate 0.05 L/min every 5 min led to a PaCO2 increase of more than 20 mmHg of apnea. The results of the AT was positive. When he was determined brain dead, his parents decided to donate his organs. AT can be performed on potential donor children on ECMO by decreasing the sweep gas flow. It is a safe and effective method and is important for BD determination.
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Affiliation(s)
- Lingling Xu
- Department of Pediatric Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yujian Liang
- Department of Pediatric Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuan Liao
- Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jian Rong
- Department of Extracorporeal Circulation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guixing Xu
- Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wen Tang
- Department of Pediatric Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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10
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The Physiology of the Apnea Test for Brain Death Determination in ECMO: Arguments for Blending Carbon Dioxide. Neurocrit Care 2019; 31:567-572. [DOI: 10.1007/s12028-019-00784-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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11
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Meadows C, Toolan M, Slack A, Newman S, Ostermann M, Camporota L, Gardiner D, Webb S, Barker J, Vuylsteke A, Harvey C, Ledot S, Scott I, Barrett NA. Diagnosis of death using neurological criteria in adult patients on extracorporeal membrane oxygenation: Development of UK guidance. J Intensive Care Soc 2019; 21:28-32. [PMID: 32284715 DOI: 10.1177/1751143719832170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The diagnosis of death using neurological criteria is an important legal method of establishing death in the UK. The safety of the diagnosis lies in the exclusion of conditions which may mask the diagnosis and the testing of the fundamental reflexes of the brainstem including the apnoea reflex. Extracorporeal membrane oxygenation for cardiac or respiratory support can impact upon these tests, both through drug sequestration in the circuit and also through the ability to undertake the apnoea test. Until recently, there has been no nationally accepted guidance regarding the conduct of the tests to undertake the diagnosis of death using neurological criteria for a patient on extracorporeal membrane oxygenation. This article considers both the background to and the process of guideline development.
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Affiliation(s)
- Cis Meadows
- Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Toolan
- Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Slack
- Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S Newman
- Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,NHS Blood and Transplant, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - M Ostermann
- Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - L Camporota
- Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - D Gardiner
- NHS Blood and Transplant, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Webb
- Department of Critical Care Medicine, Royal Papworth NHS Foundation Trust, Cambridge, UK.,Joint Standards Committee of the Intensive Care Society & Faculty of Intensive Care Medicine, London, UK
| | - J Barker
- Department of Critical Care Medicine, Manchester University Hospitals, Manchester, UK
| | - A Vuylsteke
- Department of Critical Care Medicine, Royal Papworth NHS Foundation Trust, Cambridge, UK
| | - C Harvey
- Department of Critical Care Medicine, University Hospital of Leicester, Leicester, UK
| | - S Ledot
- Department of Critical Care Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - I Scott
- Department of Critical Care Medicine, Aberdeen Royal Infirmary, Aberdeen, UK
| | - N A Barrett
- Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
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12
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Chang W. Extracorporeal Life Support in Organ Transplant Donors. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 51:328-332. [PMID: 30402392 PMCID: PMC6200175 DOI: 10.5090/kjtcs.2018.51.5.328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/02/2018] [Accepted: 03/16/2018] [Indexed: 11/28/2022]
Abstract
Background Extracorporeal life support (ECLS) can be applied in brain-dead donors for organ perfusion before donation, thereby expanding the donor pool. The aim of this study was to examine the benefits and early clinical outcomes of ECLS for organ preservation. Methods Between June 2012 and April 2017, 9 patients received ECLS with therapeutic intent or for organ preservation. The following data were collected: demographics, purpose and duration of ECLS, cause of death, dose of vasoactive drugs, and need for temporary dialysis before organ retrieval. The early clinical outcomes of recipients were studied, as well as survival and graft function at 1 month. Results ECLS was initiated for extracorporeal cardiopulmonary resuscitation in 5 patients. The other patients needed ECLS due to hemodynamic deterioration during the assessment of brain death. We successfully retrieved 18 kidneys, 7 livers, and 1 heart from 9 donors. All organs were transplanted and none were discarded. Only 1 case of delayed kidney graft function was noted, and all 26 recipients were discharged without any significant complications. Conclusion The benefits of protecting the vital organs of donors is significant, and ECLS for organ preservation can be widely used in the transplantation field.
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Affiliation(s)
- Wonho Chang
- Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Seoul Hospital
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13
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Panholzer B, Huenges K, Cremer J, Haneya A. Cardiac Graft from Donors with Extracorporeal Support-A Report of Two Cases. Thorac Cardiovasc Surg Rep 2018; 7:e33-e34. [PMID: 29977737 PMCID: PMC6023715 DOI: 10.1055/s-0038-1661410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/23/2018] [Indexed: 11/21/2022] Open
Abstract
The persistent global shortage of organ donors is still a major limitation for transplantation. Experiences of heart transplantation from donors with extracorporeal support are rare. Here, we report from two cases of donors who were supported by extracorporeal membrane oxygenation due to acute circulatory failure. In both cases, the direct postoperative course was uneventful and free from major complications. The patients were discharged to a rehabilitation clinic. Our experience suggests that the use of heart organ from carefully selected donors with extracorporeal support is possible and may lead to an excellent outcome.
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Affiliation(s)
- Bernd Panholzer
- Department of Cardiovascular Surgery, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Katharina Huenges
- Department of Cardiovascular Surgery, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Jochen Cremer
- Department of Cardiovascular Surgery, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Assad Haneya
- Department of Cardiovascular Surgery, University of Schleswig-Holstein Campus Kiel, Kiel, Germany
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14
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Assalino M, Majno P, Toso C, Berney T, Giraud R, Dutkowski P, Andres A, Wildhaber B, Elkrief L. In situ liver splitting under extracorporeal membrane oxygenation in brain-dead donor. Am J Transplant 2018; 18:258-261. [PMID: 28801937 DOI: 10.1111/ajt.14461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/21/2017] [Accepted: 08/01/2017] [Indexed: 01/25/2023]
Abstract
Hemodynamic instability is generally considered as a contraindication to liver splitting, in particular when using an in situ technique. We describe the cases of two young donors with brain death in whom refractory cardiac arrest and hemodynamic instability were supported by veno-arterial extracorporeal membrane oxygenation (VA-ECMO), allowing uneventful in situ splitting. Two adult and two pediatric liver recipients were successfully transplanted with immediate graft function. Favorable outcomes were also observed for the other transplanted organs, including one heart, two lungs, and four kidneys. Refractory cardiac arrest and hemodynamic instability corrected by VA-ECMO should not be considered as a contraindication to in situ liver splitting.
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Affiliation(s)
- Michela Assalino
- Division of Transplantation, Department of Surgery, University Hospitals, Geneva, Switzerland
| | - Pietro Majno
- Division of Transplantation, Department of Surgery, University Hospitals, Geneva, Switzerland.,HPB Center, University Hospitals of Geneva, Geneva, Switzerland
| | - Christian Toso
- Division of Transplantation, Department of Surgery, University Hospitals, Geneva, Switzerland
| | - Thierry Berney
- Division of Transplantation, Department of Surgery, University Hospitals, Geneva, Switzerland
| | - Raphaël Giraud
- Intensive Care University Hospitals, Geneva, Switzerland
| | - Philipp Dutkowski
- Division of Transplantation, University Hospital, Zurich, Switzerland
| | - Axel Andres
- Division of Transplantation, Department of Surgery, University Hospitals, Geneva, Switzerland
| | - Barbara Wildhaber
- University Center of Pediatric Surgery of Western Switzerland, University Hospitals, Geneva, Switzerland
| | - Laure Elkrief
- Division of Transplantation, Department of Surgery, University Hospitals, Geneva, Switzerland
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15
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Sharma A, Kumar S, Dutta P, Kumar P, Attawar S. Extracorporeal support for donation after cardiac death: a new avatar of ECMO. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-017-0519-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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16
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Abstract
OBJECTIVES To describe donors after brain death with ongoing extracorporeal membrane oxygenation and to analyze the outcome of organs transplanted from these donors. DESIGN Retrospective analysis of the national information system run by the French Biomedicine Agency (CRISTAL database). SETTING National registry data of all donors after brain death in France and their organ recipients between 2007 and 2013. PATIENTS Donors after brain death and their organ recipients. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS During the study period, there were 22,270 brain-dead patients diagnosed in France, of whom 161 with extracorporeal membrane oxygenation. Among these patients, 64 donors on extracorporeal membrane oxygenation and 10,805 donors without extracorporeal membrane oxygenation had at least one organ retrieved. Donors on extracorporeal membrane oxygenation were significantly younger and had more severe intensive care medical conditions (hemodynamic, biological, renal, and liver insults) than donors without extracorporeal membrane oxygenation. One hundred nine kidneys, 37 livers, seven hearts, and one lung were successfully transplanted from donors on extracorporeal membrane oxygenation. We found no significant difference in 1-year kidney graft survival (p = 0.24) and function between recipients from donors on extracorporeal membrane oxygenation (92.7% [85.9-96.3%]) and matching recipients from donors without extracorporeal membrane oxygenation (95.4% [93.0-97.0%]). We also found no significant difference in 1-year liver recipient survival (p = 0.91): 86.5% (70.5-94.1) from donors on extracorporeal membrane oxygenation versus 80.7% (79.8-81.6) from donors without extracorporeal membrane oxygenation. CONCLUSIONS Brain-dead patients with ongoing extracorporeal membrane oxygenation have more severe medical conditions than those without extracorporeal membrane oxygenation. However, kidney graft survival and function were no different than usual. Brain-dead patients with ongoing extracorporeal membrane oxygenation are suitable for organ procurement.
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Dalle Ave AL, Gardiner D, Shaw DM. The ethics of extracorporeal membrane oxygenation in brain-dead potential organ donors. Transpl Int 2016; 29:612-8. [DOI: 10.1111/tri.12772] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 01/20/2016] [Accepted: 03/01/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Anne L. Dalle Ave
- Ethics Unit; University Hospital of Lausanne; Lausanne Switzerland
- Institute for Biomedical Ethics; University Medical Center; Geneva Switzerland
| | - Dale Gardiner
- Nottingham University Hospitals NHS Trust; Nottingham UK
| | - David M. Shaw
- Institute for Biomedical Ethics; University of Basel; Basel Switzerland
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18
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Arroyo D, Gasche Y, Banfi C, Stiasny B, Bendjelid K, Giraud R. Successful heart transplantation after prolonged cardiac arrest and extracorporeal life support in organ donor-a case report. J Cardiothorac Surg 2015; 10:186. [PMID: 26682544 PMCID: PMC4684616 DOI: 10.1186/s13019-015-0393-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 12/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although heart transplantation is a successful therapy for patients suffering from end-stage heart failure, the therapeutic is limited by the lack of organs. Donor cardiac arrest is a classic hindrance to heart retrieval as it raises issues on post-transplant outcomes. CASE PRESENTATION The present case reports a successful heart transplantation after prolonged donor cardiac arrest (total lowflow time of 95 minutes) due to anaphylactic shock necessitating extracorporeal life support. We further provide an overview of the current evidence and outcomes of heart transplantation in cases of donor cardiac arrest. CONCLUSION Providing that donor and recipient criteria are respected, donor cardiac arrest does not seem to be an adverse predictor in heart transplantation.
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Affiliation(s)
- Diego Arroyo
- Intensive Care Unit, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, CH-1211, Geneva, Switzerland. .,Geneva Hemodynamic Research Group, Geneva, Switzerland.
| | - Yvan Gasche
- Intensive Care Unit, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, CH-1211, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Carlo Banfi
- Division of Cardiovascular Surgery, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Geneva Hemodynamic Research Group, Geneva, Switzerland
| | - Brian Stiasny
- Divisions of Pediatric Cardiology and Children's Research Centre, University Children's Hospital Zurich, Geneva, Switzerland
| | - Karim Bendjelid
- Intensive Care Unit, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, CH-1211, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Geneva Hemodynamic Research Group, Geneva, Switzerland
| | - Raphaël Giraud
- Intensive Care Unit, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, CH-1211, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Geneva Hemodynamic Research Group, Geneva, Switzerland
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Lee H, Cho YH, Sung K, Yang JH, Chung CR, Jeon K, Suh GY. The Use of Extracorporeal Circulation in Suspected Brain Dead Organ Donors with Cardiopulmonary Collapse. J Korean Med Sci 2015; 30:1911-4. [PMID: 26713070 PMCID: PMC4689839 DOI: 10.3346/jkms.2015.30.12.1911] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 03/24/2015] [Indexed: 11/20/2022] Open
Abstract
Donor shortage is a major limitation in organ transplantation. Several studies have reported that extracorporeal membrane oxygenation (ECMO)-assisted organ donation can be successfully completed without inducing warm ischemia in patients with brain death. The present report described clinical experience of three patients (23-yr old man, 32-yr old man, and 41-yr old woman) who underwent ECMO for the evaluation of brain death and organ donation. They donated six kidneys, three livers, and one both lungs without warm ischemia by ECMO. Six kidney recipients successfully recovered normal status without hemodialysis and two liver recipients survived with normal liver functions, but one liver recipient and one lung recipient died 3 and 15 days after transplantation. Our report strongly encourages ECMO-assisted organ donation from brain death patients with refractory cardiopulmonary collapse to achieve improved organ transplantation.
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Affiliation(s)
- Hyun Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gee Young Suh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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20
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Shah V, Lazaridis C. Apnea testing on extracorporeal membrane oxygenation: Case report and literature review. J Crit Care 2015; 30:784-6. [DOI: 10.1016/j.jcrc.2015.03.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 03/23/2015] [Accepted: 03/28/2015] [Indexed: 10/23/2022]
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21
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Balsorano P, Ciapetti M, Cianchi G, Bonizzoli M, Migliaccio ML, Ferraro MC, Franci A, Peris A. Extracorporeal life support and multiorgan donation in a severe polytrauma patient: A case report. Int J Surg Case Rep 2015; 9:109-11. [PMID: 25756801 PMCID: PMC4392376 DOI: 10.1016/j.ijscr.2015.02.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 02/16/2015] [Accepted: 02/27/2015] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Organ availability represents a key factor in transplants due to an almost universal shortage of deceased donors. PRESENTATION OF CASE We present the case of a 41-year-old patients with severe polytrauma, where extracorporeal life support (ECLS) allowed brain death (BD) declaration and multiorgan retrieval and transplantation. DISCUSSION Organ procurement is of utmost importance for transplant procedures. The presented case could rise ethical doubts as ECLS could be viewed as a tool for organ preservation instead of patient support. Nonetheless, it is obvious how organ preservation represents the necessary condition for patient preservation. CONCLUSION Besides it' role in non heart beating donors, ECLS is emerging as an adjunctive tool for brain dead donors management when standard treatment fails, potentially allowing a substantial increase in organ availability.
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Affiliation(s)
- Paolo Balsorano
- Department of Health Science, Section of Anaesthesiology, Intensive Care and Pain medicine, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy.
| | - Marco Ciapetti
- Anestesiology and Emergency and Trauma Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy.
| | - Giovanni Cianchi
- Anestesiology and Emergency and Trauma Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy.
| | - Manuela Bonizzoli
- Anestesiology and Emergency and Trauma Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy.
| | - Maria Luisa Migliaccio
- Anestesiology and Emergency and Trauma Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy.
| | - Maria Cristina Ferraro
- Anestesiology and Emergency and Trauma Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy.
| | - Andrea Franci
- Anestesiology and Emergency and Trauma Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy.
| | - Adriano Peris
- Anestesiology and Emergency and Trauma Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy.
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22
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Short-term result of renal transplantation using extracorporeal membrane oxygenation-supported brain-dead donors. Transplant Proc 2015; 46:1061-3. [PMID: 24815128 DOI: 10.1016/j.transproceed.2013.10.062] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 10/02/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is now widely used to maintain hemodynamic stability after traumatic events among medical centers. It remains unclear whether renal transplantation using ECMO-supported donors carries poorer outcomes. METHODS From February 2010 to March 2013, we performed 9 renal transplantations (6 females and 3 males) from 5 ECMO-supported donors. Demographic data and clinical outcomes were retrospectively analyzed through medical chart review. RESULTS The mean follow-up period was 15 ± 9 months (range: 8-37). Eight of the 9 grafts remained functioning within the follow-up period. One (11.1%) graft loss was noted after repeated acute rejection. Acute rejection occurred in 3/9 (33%) of cases. Delayed graft function was also observed in 3/9 (33%) of cases. CONCLUSION Renal transplantation using ECMO-supported brain-dead donors was not associated with an unacceptably high rate of graft loss in this short-term follow-up. It might be an alternative way to expand donor pools.
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23
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Hoskote SS, Fugate JE, Wijdicks EF. Performance of an Apnea Test for Brain Death Determination in a Patient Receiving Venoarterial Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth 2014; 28:1027-9. [DOI: 10.1053/j.jvca.2013.12.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Indexed: 11/11/2022]
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24
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Yang JH, Cho YH, Chung CR, Jeon K, Park CM, Suh GY. Use of Extracorporeal Membrane Oxygenation for Optimal Organ Donation. Korean J Crit Care Med 2014. [DOI: 10.4266/kjccm.2014.29.3.194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jeong Hoon Yang
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chi-Min Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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25
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Apnea Test for Brain Death Determination in a Patient on Extracorporeal Membrane Oxygenation. Neurocrit Care 2013; 19:215-7. [DOI: 10.1007/s12028-013-9845-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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Kim YH, Sohn GY, Jung YJ, Kyoung KH, Hong SK. Successful Management of Potential Non-Heart-Beating Donor with Extracorporeal Membrane Oxygenation - A Case Report -. Korean J Crit Care Med 2012. [DOI: 10.4266/kjccm.2012.27.4.279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Young Hwan Kim
- Division of Trauma and Surgical Critical Care, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gui Yun Sohn
- Division of Trauma and Surgical Critical Care, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Kyu Hyouck Kyoung
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Suk-Kyung Hong
- Division of Trauma and Surgical Critical Care, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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