Lung transplantation from controlled donation after circulatory death using simultaneous abdominal normothermic regional perfusion: A single center experience.

Despite the benefits of abdominal normothermic regional perfusion (A-NRP) for abdominal grafts in controlled donation after circulatory death (cDCD), there is limited information on the effect of A-NRP on the quality of the cDCD lungs. We aimed to study the effect of A-NRP in lungs obtained from cDCD and its impact on recipients´ outcomes. This is a study comparing outcomes of lung transplants (LT) from cDCD donors (September 2014 to December 2021) obtained using A-NRP as the abdominal preservation method. As controls, all lung recipients transplanted from donors after brain death (DBD) were considered. The primary outcomes were lung recipient 3-month, 1-year, and 5-year survival. A total of 269 LT were performed (60 cDCD and 209 DBD). There was no difference in survival at 3 months (98.3% cDCD vs. 93.7% DBD), 1 year (90.9% vs. 87.2%), and 5 years (68.7% vs. 69%). LT from the cDCD group had a higher rate of primary graft dysfunction grade 3 at 72 h (10% vs. 3.4%; p <  .001). This is the largest experience ever reported with the use of A-NRP combined with lung retrieval in cDCD donors. This combined method is safe for lung grafts presenting short-term survival outcomes equivalent to those transplanted through DBD.

La simulación como herramienta para facilitar la adaptación de la organización sanitaria a la pandemia de COVID-19

Resumen Introducción: Durante la pandemia COVID-19 es necesario que los profesionales actualicen conocimientos, actitudes y habilidades para tratar la infección, y se protejan frente al contagio con suministros sanitarios limitados. Se describe el empleo estratégico de un centro de simulación para facilitar la adaptación de un servicio de salud a la pandemia. Métodos: Se analiza la experiencia de un centro de simulación en Cantabria, España. Un grupo de trabajo identifica y clasifica las necesidades en tres áreas: 1) aprendizaje (categorizadas con un sistema de zonas para adaptar el diseño e implementación del entrenamiento a las necesidades específicas);2) innovación (relacionadas con la práctica asistencial y el equipamiento sanitario);y 3) suministros sanitarios (que pueden fabricarse con las impresoras 3D disponibles en el centro de simulación para material docente). Resultados: 1) Se implementan tres tipos de actividades de entrenamiento: talleres de formación de formadores para protección frente a trasmisión por gota-contacto, simulaciones para la protección frente a contagio por aerosoles y un marco de trabajo para el análisis de las situaciones con pacientes reales. 2) Se analizan máscaras de buceo para asistencia ventilatoria, prototipos de ventiladores y técnicas para ventilar dos pacientes con un ventilador. 3) Se fabrican máscaras de protección facial, hisopos para la toma de muestras y horquillas para mascarillas. Conclusión: La participación estratégica de un centro de simulación puede promover y facilitar la adaptación de un sistema de salud a una epidemia por COVID-19. Introduction: During the COVID-19 pandemic professionals need to update the knowledge, attitudes and skills necessary to treat infected patients, and protect themselves against the transmission of the disease with limited medical supplies. The strategic use of a simulation center to facilitate the adaptation of a health service to the pandemic is described. Methods: The experience of a simulation center in Cantabria, Spain is analyzed. A working group identifies and classifies organizational needs into three areas: 1) learning (categorized with a zone system to tailor the design and implementation of training to specific needs);2) innovation (related to healthcare practice and healthcare equipment);and 3) sanitary supplies (which can be manufactured with the 3D printers available in the simulation center for teaching materials). Results: 1) Three types of simulation training activities are implemented: train the trainer workshops for protection against drop-contact transmission, simulations for protection against aerosol transmission and a framework for the analysis of real situations with patients. 2) Diving masks for ventilatory assistance, techniques for ventilating two patients with one ventilator and prototype ventilators are analyzed. 3) Facial protection masks, swabs and mask forks are printed. Conclusion: The strategic participation of a simulation center can promote and facilitate the adaptation of a health system to a COVID-19 pandemic.