Expedited organ donation in Victoria, Australia: donor characteristics and donation outcomes.

Background: Deceased organ donation work-up typically takes 24 hours or more. Clinicians may thus discount the possibility of donation when the potential donor is physiologically unstable or family requirements do not allow this length of time. This may lead to loss of transplantable organs. In 2015, we introduced an expedited work-up guideline with the aim of facilitating donation in these circumstances and maximising donation potential. Objective: To determine the number of expedited work-up (consent to retrieval procedure of 6 hours or less) donors from 2015 to 2018, compare their clinical and demographic characteristics with standard donors, and assess the outcome of transplanted organs and organ recipients. Design: We performed a retrospective audit of the electronic database for all Victorian donors from 2015 to 2018. We obtained transplant outcome data from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). Results: Overall, 38 expedited pathway donors donated 78 organs for transplantation (70 kidneys, four lungs, three livers, one pancreas). Of these, 55 retrieved kidneys were successfully transplanted. The lungs, livers and pancreas retrieved were all transplanted. For the kidney recipients, early graft dysfunction requiring dialysis was more common than with organs from the standard pathway (71% v 38%; P < 0.0001); however, short and medium term graft and patient survival were similar. Three recipients from the expedited pool experienced graft failure and two subsequently died. Of the two lung recipients, one died at day 622 of chronic rejection. Conclusions: Expedited pathway donation is feasible with acceptable donation outcomes. Clinicians should consider donation even when physiological instability or family requirements preclude standard organ donation work-up times.

A comparison of therapeutic hypothermia and strict therapeutic normothermia after cardiac arrest.

BACKGROUND AND AIMS: In a recent high-quality randomised controlled trial (RCT), strict therapeutic normothermia (STN) following cardiac arrest with coma resulted in similar outcomes to therapeutic hypothermia (TH). We aimed to test the feasibility, reproducibility, and safety of the STN protocol outside of its RCT context. METHODS: In two teaching hospital ICUs, we performed a before-and-after study comparing the previously International Liaison Committee on Resuscitation (ILCOR)-endorsed TH protocol to the recently studied STN protocol. The primary feasibility end point was the percentage of temperature recordings in the prescribed range in the first 24h of treatment. Secondary end points included pharmacological management and complications. RESULTS: We studied 69 similar patients in each group. We found no difference in feasibility as shown by the proportion of within range temperatures. However, the median doses of midazolam (37mg vs. 9mg, p=0.02), fentanyl (883µg vs. 310µg, p=0.01) and the use of muscle relaxants (84.1% vs. 59.4%, p=0.001) was greater with the TH protocol. Furthermore, shivering (52.2% vs. 18.8%, p<0.001), a composite of other pre-defined complications (66.7% vs. 47.8%, p<0.03) and fever in the first 96h (55.1% vs. 33.3%, p=0.01) were also more common with the TH protocol. CONCLUSIONS: The STN protocol was successfully reproduced outside of an RCT and appeared associated with fewer complications than the TH protocol. Our findings imply that the STN protocol may offer clinical advantages over the TH protocol.

Comparison of pseudophakic dysphotopsia with Akreos Adapt and SN60-AT intraocular lenses.

PURPOSE: To determine the relative incidence of unwanted light images with the AcrySof SN60-AT intraocular lens (IOL) (Alcon) and the Akreos Adapt (Bausch & Lomb) IOL. SETTING: The Eye Clinic, Sir Charles Gairdner Hospital, Nedlands, Australia. METHODS: In a prospective randomized study of 61 patients who had cataract surgery, the relative incidence of unwanted light images with 2 biconvex acrylic double square-edged IOLs, the SN60-AT and Akreos Adapt, was compared. Patients were followed at 1 week and for a minimum of 6 weeks. At both follow-ups, patients were asked to rate their experience of dysphotopic phenomenon according to a set of questionnaire criteria. The Mann-Whitney test was used to analyze the ordinal data. RESULTS: All 61 patients were interviewed at both stages of follow-up. The mean follow-up was 8 weeks +/- 2 (SD). At 1 week, there was significantly more dysphotopsia (positive and negative) with the SN60-AT IOL (37.5%) than with the Akreos Adapt IOL (24.1%) (P = .042). Significantly more patients with the SN60-AT IOL reported negative dysphotopsia at 1 week only. At 8 weeks, the incidence of positive and negative dysphotopsia declined to 31.3% and 20.7% in the SN60-AT group and Akreos Adapt group, respectively, and there was no longer a statistically significant difference between the 2 groups. CONCLUSIONS: More patients with the SN60-AT IOL than with the Akreos Adapt IOL reported dysphotopsia. One week postoperatively, the difference was significant. The difference was primarily a result of the higher incidence of negative dysphotopsia with the SN60-AT IOL. At 8 weeks, the incidence of all types of light phenomena was significantly lower in both groups.