Parada cardiaca extrahospitalaria secundaria a infarto aislado del ventrículo derecho / Prehospital cardiac arrest secondary to isolated right ventricular infarction

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Aplicación de cardiocompresores mecánicos en el donante tras una muerte cardiaca extrahospitalaria / Mechanical cardiopump use in organ donation after prehospital cardiac death

Objetivo: El Servicio de Urgencias Médicas de Madrid SUMMA112, en colaboración con dos hospitales de Madrid, está inmerso en un programa de donación de órganos de pacientes que han sufrido una parada cardiaca extrahospitalaria y no han respondido a las maniobras de resucitación. El objetivo de este estudio es valorar los resultados de la aplicación 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 cardiocompresores. 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 cardiocompresor, el tiempo de llegada a la escena y el tiempo desde la alerta a la llegada al hospital. Como variables dependientes 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 (AU)

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 (interquartilerange) 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 themean 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 ofextracted organs (AU)

Kidney transplant function using organs from non-heart-beating donors maintained by mechanical chest compressions.

OBJECTIVE: This study aims to determine the failure rate of transplanted kidney grafts in recipients of organs from non-heart beating donors (NHBDs) who have had mechanical chest compressions to maintain a circulation before organ retrieval. METHODS: A retrospective observational study based on review of the emergency medical service database and case histories of NHBDs, and information periodically sent by transplant units about donors and organs. The following variables were studied: age, sex, transfer hospital, time to arrival on the scene of cardiopulmonary arrest, time to arrival in hospital, number and type of organs retrieved, use of mechanical chest compression devices, and kidney function in graft recipients. The study covered the period between January 2008 and November 2009. During 2008 standard manual chest compressions were used and during 2009 mechanical chest compression devices were used. RESULTS: In 39 transplanted kidneys from donors receiving mechanical chest compressions primary failure was documented in recipients on two occasions (5.1%). Kidneys transplanted from donors who had manual chest compressions resulted in three primary failures in recipients (9.1%). The difference between the two groups was not significant (p=0.5). Three patients achieved successful return of spontaneous circulation in the mechanical chest compression group after initiation of the NHBD donor protocol. CONCLUSION: We have described our experience and protocol for non-heart beating donation using victims of out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation has been unsuccessful as donors. Primary kidney graft failure rates in organs from non-heart beating donors is similar when manual or mechanical chest compression devices are used during cardiopulmonary resuscitation.