From the Intensive Care Unit and Regional Extracorporeal Membrane Oxygenation Referral Centre, Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Exp Clin Transplant. 2024 Jun;22(6):421-425. doi: 10.6002/ect.2024.0115.
We investigated donors with brain death on extracorporeal membrane oxygenation support, a clinically challenging situation due to hemodynamic instability frequently encountered in these donors, which may threaten organ function.
We described our experience with 15 utilized brain death donors on extracorporeal membrane oxygenation support, consecutively admit-ted in our intensive care unit (which is a referral center for extracorporeal membrane oxygenation) from 2018 to 2023. We investigated whether utilization rate for brain death donors on extracor-poreal membrane oxygenation was affected by the introduction of a monitoring hemodynamic schedule during the 6-hour observation period.
The utilization rate was 78% in period 1 and 88% in period 2. No statistically significant differences were observed for age, sex, and the incidence of cardiovascular risk factors between period 1 and period 2. The cause of death was postanoxic encephalopathy in all but 1 donor, who was on venovenous extracorporeal membrane oxygenation for refractory respiratory failure and developed cerebral hemorrhage. Number of organs per donor was 2 in all the population with no significant differences between period 1 and period 2. In the overall population, 15 livers were transplanted, 11 kidneys, 1 heart, and 1 pancreas. In our population, left ventricular ejection fraction severe dysfunction was observed in all donors except in the donor on venovenous extracorporeal membrane oxygenation; the organ from this donor was deemed unsuitable for transplant. No significant differences were observed in hemodynamic data between the 2 subgroups. All donors were on 2 vasoactive drugs (norepinephrine and vasopressin) to maintain adequate perfusion (mean arterial pressure >60 mm Hg). Three donors were oligoanuric (due to postarrest acute renal failure).
In our series of 15 consecutive brain death donors on extracorporeal membrane oxygenation, a strict monitoring regimen during the 6-hour obser-vation period was associated with a higher utilization rate.
我们研究了在体外膜肺氧合（ECMO）支持下发生脑死亡的供者，这种情况具有临床挑战性，因为这些供者经常出现血流动力学不稳定，这可能会威胁到器官功能。
我们描述了 2018 年至 2023 年期间在我们的重症监护病房（ECMO 转诊中心）连续收治的 15 例脑死亡供者的经验，这些供者在 ECMO 支持下发生脑死亡。我们研究了在 6 小时观察期间引入血流动力学监测方案是否会影响脑死亡供者的使用率。
第 1 期的使用率为 78%，第 2 期为 88%。第 1 期和第 2 期之间在年龄、性别和心血管危险因素的发生率方面没有观察到统计学上的显著差异。除了 1 例因难治性呼吸衰竭而接受静脉-静脉 ECMO 并发生脑出血的供者外，其余供者的死亡原因均为缺血缺氧性脑病。所有供者的每个供者器官数均为 2 个，第 1 期和第 2 期之间无显著差异。在所有人群中，共进行了 15 例肝移植、11 例肾移植、1 例心脏移植和 1 例胰腺移植。在我们的人群中，除了静脉-静脉 ECMO 的供者外，所有供者的左心室射血分数均严重功能障碍；该供者的器官被认为不适合移植。在 2 个亚组之间，血流动力学数据没有观察到显著差异。所有供者均使用 2 种血管活性药物（去甲肾上腺素和血管加压素）来维持足够的灌注（平均动脉压＞60mmHg）。3 例供者少尿（由于心搏骤停后急性肾衰竭）。
在我们的 15 例连续 ECMO 支持下发生脑死亡的供者中，在 6 小时观察期间实施严格的监测方案与更高的使用率相关。
