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Uncontrolled DCD with Prolonged Ex Vivo Lung Perfusion (EVLP): A Feasible Model for Donor Lung Recovery and Allocation

2016; Elsevier BV; Volume: 35; Issue: 4 Linguagem: Inglês

10.1016/j.healun.2016.01.873

1557-3117

John R. Spratt, Lars M. Mattison, Paul A. Iaizzo, Tinen L. Iles, William D. Payne, Gabriel Loor,

Cardiac Arrest and Resuscitation

Uncontrolled Donation after Cardiac Death (DCD) has not been routinely adopted in the United States due to logistics of organ allocation and assessment. We describe a model of uncontrolled DCD (Maastricht II), studying the effect of the warm ischemic interval and ventilation strategy on organ viability with prolonged recovery on EVLP. Adult male swine were anesthetized, ventilated, and heparinized. In the control group (n=4), cardiac arrest was induced and lungs were procured immediately. In the treatment groups, swine experienced a 15-minute period of agonal hypoxia and cardiac arrest followed by either 1H of warm ischemia with (n=4) or without (n=3) mechanical ventilation (6cc/kg, PEEP 5 mmHg) or 2H of warm ischemia with (n=3) or without (n=4) ventilation. Lungs were then flushed, placed on the Organ Care System (OCS) portable EVLP platform, and underwent normothermic ventilation and perfusion for 24H using autologous donor whole blood and standard additives. Continuous variables were compared using analysis of variance. The initial 6 hours on EVLP showed impaired tidal volume (VT), peak airway pressures (PAWP), vascular resistance (VR), pulmonary artery pressures (PAP), and PF ratios in all DCD groups compared with controls (Table 1). The least impairment and fastest recovery was observed in the 1H vent group while the worse initial injury was seen in the 2H no-vent group. All respiratory and hemodynamic parameters normalized by 24H on EVLP in all groups. However, only controls and 1H vent met transplant criteria at 24H (PaO2:FiO2 >300mmHg). Both of these groups showed improvement in PF ratio from baseline to 24H, mirroring improvement in respiratory and hemodynamic parameters. Uncontrolled DCD following a witnessed cardiac arrest (Maastricht II) is a feasible mode of DCD recovery if limited to one hour of warm ischemia with ventilation. OCS perfusion with autologous whole donor blood allows sufficient time for organ optimization and allocation.Tabled 1Functional Recovery After 24H of Portable EVLPFunctional Parameter (mean±SD)Whole Blood1H Vent1H No Vent2H Vent2H No VentPInitial % Goal VT100±096±669±2444±360±150.00124H % Goal VT100±0100±0100±0100±0100±01Initial PAWP (mmHg)19±320±423±125±124±10.03624H PAWP (mmHg)16±115±219±320±418±30.260Initial VR (dyn*s*cm-5)614±41816±51123±4361003±251091±460.15124H VR (dyn*s*cm-5)333±41366±5622±436337±25377±460.432Initial PAP (mmHg)10±113±118±416±217±20.00424H PAP (mmHg)7±07±012±86±07±10.453Initial PF335±66375±153251±21219±8213±280.20824H PF541±139405±181232±60254±52236±280.045 Open table in a new tab