An integrated program of extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation and uncontrolled donation after circulatory determination of death in refractory cardiac arrest

Roncon‐Albuquerque, Roberto; Gaião, Sérgio; Figueiredo, Paulo Tadeu de Souza; Príncipe, Nuno; Basílio, Carla; Mergulhão, Paulo; Silva, Sofia; Honrado, Teresa; Cruz, Francisco; Pestana, Manuel; Oliveira, Gerardo; Meira, Luis; França, Ana Paula Figueiredo de Montalvão; Almeida-Sousa, João Paulo; Araújo, Fernando; Paiva, José Artur

doi:10.1016/j.resuscitation.2018.10.016

Cited by 38 publications

(32 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Lungs can be retrieved a longer period after death meaning less time pressure on the local organ retrieval team. The lessons learnt from our experience will add to those of other uDCD programmes (notably in Spain, France and Holland) to optimise future uDCD 31 33 34…”

Section: Lessons Learntmentioning

confidence: 82%

See 1 more Smart Citation

Lessons from a pilot for uncontrolled donation after circulatory death in the ED in the UK

et al. 2019

View full text Add to dashboard Cite

Worldwide there is a shortage of available organs for patients requiring transplants. However, some countries such as France, Italy and Spain have had greater success by allowing donations from patients with unexpected and unrecoverable circulatory arrest who arrive in the ED. Significant advances in the surgical approach to organ recovery from donation after circulatory death (DCD) led to the establishment of a pilot programme for uncontrolled DCD in the ED of the Royal Infirmary of Edinburgh. This paper describes the programme and discusses the lessons learnt.

show abstract

Section: Lessons Learntmentioning

confidence: 82%

“…This may be beneficial for the patient in terms of survival, and should the efforts fail, could greatly facilitate the use of NRP postmortem given the conceptual similarities between the two approaches. Roncon-Albuquerque et al 31 have recently assessed the feasibility of an integrated ECMO/uDCD programme 32…”

Section: Lessons Learntmentioning

confidence: 99%

Lessons from a pilot for uncontrolled donation after circulatory death in the ED in the UK

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Therefore, if these protocols include eCPR, the uDCD pathway should only be activated when this has been terminated. The feasibility of the integration of eCPR and uDCD programs has recently been described in refractory cardiac arrest, leading to successful kidney transplantation [59].…”

Section: Extracorporeal Oxygenation Techniquesmentioning

confidence: 99%

Organ donation after circulatory death: current status and future potential

et al. 2019

View full text Add to dashboard Cite

The continuing shortage of deceased donor organs for transplantation, and the limited number of potential donors after brain death, has led to a resurgence of interest in donation after circulatory death (DCD). The processes of warm and cold ischemia threaten the viability of DCD organs, but these can be minimized by well-organized DCD pathways and new techniques of in-situ organ preservation and ex-situ resuscitation and repair post-explantation. Transplantation survival after DCD is comparable to donation after brain death despite higher rates of primary non-function and delayed graft function. Countries with successfully implemented DCD programs have achieved this primarily through the establishment of national ethical, professional and legal frameworks to address both public and professional concerns with all aspects of the DCD pathway. There remains a worldwide shortage in organ availability, and it seems unlikely that expanding standard DCD programs in isolation will be sufficient to address this. It is therefore likely that reliance on extended criteria donors will increase, with the attendant imperative to minimize ischemic injury to candidate organs. Normothermic regional perfusion and ex-situ perfusion techniques allow enhanced preservation, assessment, resuscitation and/or repair of damaged organs as a way of improving overall organ quality and preventing the unnecessary discarding of DCD organs. This review will outline exemplar controlled and uncontrolled DCD pathways, highlighting practical and logistical considerations that minimize warm and cold ischemia times while addressing potential ethical concerns. Future perspectives will also be discussed. Take home message Donation after circulatory death (DCD) is an effective means of expanding the potential donor pool, and has comparable transplantation survival to donation after brain death despite higher rates of primary nonfunction and delayed graft function. Countries with successfully implemented DCD programs have achieved this primarily through the establishment of national ethical, professional and legal frameworks to address both public and professional concerns with all aspects of the DCD pathway.

show abstract

“…29,30 However, no ethical dilemma should be observed between these two different pathways when a clear protocol has been established since inclusion criteria are quite different. 31 Of note, aCPR must be maintained as long as defibrillating rhythms are identified, which are those that could potentially benefit from E-CPR. 32 Should an E-CPR program be in place and patients fulfill the selection criteria, the corresponding process should be activated, and uDCD not considered, since aCPR strategies would have not been halted in those particular cases.…”

Section: F I G U R Ementioning

confidence: 99%

“…32 Should an E-CPR program be in place and patients fulfill the selection criteria, the corresponding process should be activated, and uDCD not considered, since aCPR strategies would have not been halted in those particular cases. 31 In our center, E-CPR is available and no criteria for activating the E-CPR pathway are mandatory to activate our uDCD program.…”

Section: F I G U R Ementioning

confidence: 99%

Strict selection criteria in uncontrolled donation after circulatory death provide excellent long‐term kidney graft survival

Miñambres

Rodrigo

Suberviola

et al. 2020

Clinical Transplantation

View full text Add to dashboard Cite

Background: We aimed to report our experience in uncontrolled donation after circulatory death (uDCD) kidney transplantation applying a strict donor selection and preservation criteria. Methods: All kidney recipients received a graft from a local uDCD. As controls, we included all renal transplants from local standard criteria donation after brain death (SDBD) donors. Normothermic regional perfusion was the preservation method in all cases. Results: A total of 19 kidneys from uDCD donors were included and 67 controls. Delayed graft function (DGF) was higher in the uDCD group (42.1% vs 17.9%; P = .033), whereas no differences were observed in primary nonfunction (0% cases vs 3% controls; P = .605). The estimated glomerular filtration rate was identical in both groups. No differences were observed in graft survival censored for death between the uDCD and the SDBD groups at 1-year (100% vs 95%) or 5-year follow-up (92% vs 91%). uDCD kidney recipients did not have higher risk of graft loss in the multivariate analysis adjusted by recipient age, cold ischemic time, presence of DGF, and second kidney transplant (HR: 0.4; 95% CI 0.02-6; P = .509). Conclusions: Obtaining renal grafts from uDCD is feasible in a small city and provides similar outcomes compared to standard DBD donors.

show abstract

An integrated program of extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation and uncontrolled donation after circulatory determination of death in refractory cardiac arrest

Cited by 38 publications

References 37 publications

Lessons from a pilot for uncontrolled donation after circulatory death in the ED in the UK

Lessons from a pilot for uncontrolled donation after circulatory death in the ED in the UK

Organ donation after circulatory death: current status and future potential

Strict selection criteria in uncontrolled donation after circulatory death provide excellent long‐term kidney graft survival

Contact Info

Product

Resources

About