Transesophageal Ultrasound-Guided Normothermic Regional Perfusion in Controlled Donors After Cardiocirculatory Determination of Death.
Marta Velia AntoniniLorenzo ViolaAlessandro CircelliMatteo BianchinGiuliano BolondiAndrea NanniVanni AgnolettiPublished in: ASAIO journal (American Society for Artificial Internal Organs : 1992) (2023)
Programs of donation after cardiocirculatory determination of death (DCD) are increasingly established in many countries to increase the availability of organs for transplantation. The use of abdominal normothermic regional reperfusion (A-NRP), shortening total warm ischemia time (tWIT), has been recently recommended by the European Society for Organ Transplantation (ESOT) to decrease the risk potentially associated with transplantation of grafts from DCD donors. We aimed to describe our transesophageal ultrasound (TEU)-guided technique to implement A-NRP in controlled DCD (cDCD) donors through femorofemoral venoarterial extracorporeal support, preventing coronary and cerebral reperfusion occluding the aorta with a balloon. After assessment of the central vascular structures, the use of TEU in real time guides the insertion of the guidewires and the balloon. Moreover, TEU allows us to verify the proper positioning of a venous cannula and aortic balloon. The entire procedure may be performed without the need for fluoroscopic or radiographic evaluation, or limiting the need for fluoroscopic or radiology assistance to a selected scenario of difficult or expected difficult cannulation and/or balloon insertion. The distribution of interventions as antemortem and postmortem reflects the scenario imposed by Italian laws regulating organ procurement in DCD donors.
Keyphrases
- ultrasound guided
- extracorporeal membrane oxygenation
- kidney transplantation
- cerebral ischemia
- acute myocardial infarction
- aortic valve
- pulmonary artery
- coronary artery
- cell therapy
- coronary artery disease
- magnetic resonance imaging
- solid phase extraction
- acute respiratory distress syndrome
- artificial intelligence
- public health
- acute ischemic stroke
- molecularly imprinted
- fine needle aspiration
- left ventricular
- physical activity
- mesenchymal stem cells
- respiratory failure
- computed tomography
- mass spectrometry
- machine learning
- pulmonary hypertension
- magnetic resonance
- deep learning
- pulmonary arterial hypertension
- aortic dissection
- contrast enhanced
- simultaneous determination
- catheter ablation