From the Department of Anaesthesia and Intensive Care, University of Pisa, Italy.
Department of Anesthesia and Intensive Care, Bufalini Hospital, Cesena, Italy.
ASAIO J. 2020 Jan;66(1):e19-e21. doi: 10.1097/MAT.0000000000000963.
Organ retrieved from donors after circulatory deaths (DCD) is vulnerable of the effects of warm ischemia with important consequence on graft survival and posttransplant outcome. Preservation techniques, such as normothermic regional perfusion (NRP), can be used to reduce the effects of the cardiac arrest and to generate a continuous flow to the organs, resulting in a better preservation of the organs for transplantation. However, technical complications may occur during NRP which can compromise the retrieve of donors' organs. We present a case report of a technical complication arisen during an NRP for DCD. During the extracorporeal circuit, we observed a dramatical decrease in the blood flow with excessive negative inlet pressure. It was because of a later recognized venous cannula malposition. In fact, we did not perform the radiological control for wire position. As a consequence, our clinical practice was modified. Currently, a radiological control of the wire is performed before the insertion of the catheter. Even if the donation was accomplished successfully, we reckon that it is fundamental to describe the technical issue that may occur during perfusion technique in order to improve the safety and the effectiveness of these procedures.
从循环死亡（DCD）供体中获取的器官容易受到热缺血的影响，这对移植物的存活和移植后的结果有重要影响。保存技术，如常温区域灌注（NRP），可用于减少心脏骤停的影响，并为器官提供持续的血流，从而更好地保存供体器官进行移植。然而，NRP 过程中可能会出现技术并发症，从而影响供体器官的获取。我们报告了一例在 DCD 的 NRP 过程中出现的技术并发症。在体外循环过程中，我们观察到血流急剧下降，入口负压过大。这是由于后来发现的静脉插管位置不当。事实上，我们没有进行导丝位置的影像学检查。因此，我们修改了临床实践。目前，在插入导管之前，对导丝进行影像学检查。即使捐献成功，我们认为描述灌注技术过程中可能出现的技术问题对于提高这些程序的安全性和有效性至关重要。
