Electroconvulsive Therapy in Super Refractory Status Epilepticus: Case Series with a Defined Protocol

Super-refractory status epilepticus (SRSE) represents a neurological emergency that is characterized by a lack of response to the third line of antiepileptic treatment, including intravenous general anesthetics. It is a medical challenge with high morbidity and mortality. Electroconvulsive therapy (ECT) has been recommended as a nonpharmacologic option of treatment after other alternatives are unsuccessful. Its effect on the cessation of SRSE has been minimally investigated. The objective of this article is to analyze the effect of ECT on SRSE. For this purpose, a multidisciplinary team created a protocol based on clinical guidelines similar to those described previously by Ray et al. (2017). ECT was applied to six patients with SRSE after the failure of antiepileptic treatment and pharmacologic coma.The objective of each ECT session was to elicit a motor seizure for at least 20 s. SRSE was resolved in all patients after several days of treatment, including ECT as a therapy, without relevant adverse effects. Thus, ECT is an effective and feasible option in the treatment of SRSE, and its place in the algorithm in treatment should be studied due to the uncommon adverse effects and the noninvasive character of the therapy

An intensive lung donor treatment protocol does not have negative influence on other grafts: a multicentre study.

Competing requirements for organ perfusion may call for antagonistic strategies such as fluid replacement or high positive end-expiratory pressure. We recently proposed an intensive lung donor treatment protocol that nearly tripled lung procurement rates and validated it in a multicentre study. The next step was to evaluate the impact of our proposal on the other organ grafts recovered from lung donors and on the recipients' outcome after transplantation of those grafts. A quasi-experimental study was conducted in six Spanish hospitals during 2013 (2010-12 was historical control). Organ donor management was led by a trained and experienced intensive care staff. A total of 618 actual donors after brain death (DBDs) were included, 453 DBDs in the control period (annual average 151) and 165 in the protocol period. No baseline differences were found between the periods. Heart, liver, kidney and pancreas retrieval rates were similar in both periods, and heart, liver, kidney and pancreas recipients' survival at 3 months showed no differences between both periods. Our lung donor treatment protocol is safe for other grafts obtained from donors undergoing these procedures with the aim of increasing lungs available for transplantation. It has no negative impact on the recovery rates of other grafts or on early survival of heart, liver, pancreas or kidney recipients