Abradelo de Usera, M.

Amado Belmonte, A.

Mateos Rodríguez, Alonso

Navalpotro Pascual, J.M.

Peinado Vallejo, F.

Río Gallegos, F.

Resuscitation

English

DDFV

MECHANICAL CHEST COMPRESSION DEVICES IMPROVE SURVIVAL OF LIVER GRAFTS FROM DONORS AFTER CARDIAC DEATH 1  To the Editor:  The use of mechanical devices to assist cardiopulmonary resuscitation (CPR) addressed to the return of spontaneous circulation (ROSC)1 2, as well as a method of organ preservation in potential donors after cardiac death (DCD)3 4, has been extensively studied. Although no clear benefit on ROSC has been reported, many Emergency Medical Services (EMS) worldwide still use them routinely because they clearly improve both safety and quality of chest compressions5. The aim of the present study was to assess mechanical chest compression (MeCC) devices as a method of organ preservation in kidney, lung and liver grafts from type IIA DCD. We analyzed the outcome of kidney grafts and 1-year survival of liver and lung grafts by comparing both out-of-hospital organ preservation methods: manual chest compressions (MaCC) versus mechanical chest compressions (MeCC).   The EMS SUMMA112, Madrid, Spain, created a database of potential DCD including the following variables: referral hospital, sex, age, time of arrival at the scene, transfer time (from alert to arrival to hospital), etiology of cardiac arrest, successful versus failed donation, number and type of retrieved organs, cause of  donation failure (as reported by hospitals), use of MeCC devices and medicalized helicopter. Depending on their availability, LUCAS1® or Autopulse® devices were used randomly during data collection period.  From 2008 to 2011, 199 cases of potential DCD were reported (152 patients undergoing MeCC and 47 MaCC). No significant differences between both groups were observed in age, time of arrival at the scene or transfer time. MECHANICAL CHEST COMPRESSION DEVICES IMPROVE SURVIVAL OF LIVER GRAFTS FROM DONORS AFTER CARDIAC DEATH 2  At least one organ was retrieved from 93 (61.2%) patients in the MeCC group and from 37 (78.7%) in the MaCC group (p=0.02, OR 2.3, 95% CI 1-5)  A total of 259 (54%) kidney grafts were retrieved from potential DCD. At least one kidney was retrieved from 122 patients, 37 (30.3%) in the MaCC group and 85 (69.7%) in the MeCC group (p=0.07, OR 0.2,  95% CI 0.2-1). No significant differences in serum creatinine levels (mg/dL) were observed between MaCC and MeCC groups. Right kidney grafts showed serum creatinine levels at 1 year of 2.2 mg/dL in the MaCC group as compared to 1.9 mg/dL in the MeCC group (t=0.60, 95% CI 0.3-0.58). Levels for left kidney grafts were 1.7 versus 1.9 mg/dL respectively (t=0.6, 95% CI -0.15-0.33).  Eighteen recipients received a total of 30 lung grafts (4 unipulmonary and 1 bipulmonary in the MaCC group and 2 unipulmonary and 11 bipulmonary in the MeCC group). Only 2 patients died during 1-year follow-up, both of them in the MeCC group. Statistical analysis was not significant due to few cases reported.   Forty-one liver grafts were retrieved, 14 in the MaCC group and 27 in the MeCC group. One-year liver graft survival was 5 versus 9 in the MaCC group and 24 versus 3 in the MeCC group (p=0.001, OR 16.6, 95% CI 2.9-84.3)  According to our data, although the use of MeCC devices influences adversely organ retrieval from DCD, reported data may be influenced by multiple factors such as  retrospective data collection, a lot of variables playing a role in DCD and several uncontrolled techniques, including learning curve from early to recent years of the protocol. MECHANICAL CHEST COMPRESSION DEVICES IMPROVE SURVIVAL OF LIVER GRAFTS FROM DONORS AFTER CARDIAC DEATH 3   Despite such limitations, a significant difference between groups was observed in liver graft survival. Although learning curve during the early years of the study period may play a significant role, the highly significant statistical difference favoring the use of MeCC devices must be emphasized.    MECHANICAL CHEST COMPRESSION DEVICES IMPROVE SURVIVAL OF LIVER GRAFTS FROM DONORS AFTER CARDIAC DEATH 4  REFERENCES 1 Wik L1, Olsen JA2, Persse D3, Sterz F4, Lozano M5, Brouwer MA6, Westfall M7, Souders CM3, Malzer R8, van Grunsven PM9, Travis DT10, Whitehead A11, Herken UR12, Lerner EB13. Manual vs. integrated automatic load-distributing band CPR with equal survival after out of hospital cardiac arrest. The randomized CIRC trial. Resuscitation. 2014 Mar 15. PMID:24642406.  2 Rubertsson S, Lindgren E, Smekal D, et al. Mechanical Chest Compressions and Simultaneous Defibrillation vs Conventional Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest: The LINC Randomized Trial. JAMA. 2014;311(1):53-61. doi:10.1001/jama.2013.282538.  3 Alonso A. Mateos-Rodríguez, José María Navalpotro-Pascual, Amado Andres- Belmonte.Donor after cardiac death kidney graft under mechanical cardiac compression evolution. Resuscitation 2013;84:117-119  4 Carmona Jiménez F, Ruiz Arránz A, Palma Padró P, Soto García A, Alberola Martín M, Saavedra Escobar S. Utilización de un compresor torácico mecánico (LUCAS®) en un programa de donación en asistolia: efecto sobre la perfusión de los órganos y la tasa de trasplante. Emergencias 2012; 24: 366-371.  5 Steen S, Liao Q, Pierre L, Paskevicius A, Sjoberg T. Evaluation of LUCAS, a new device for automatic mechanical compression and active decompression resuscitation. Resuscitation 2002; 55:285-99.                                                            

Mechanical chest compression devices improve survival of liver grafts from donors after cardiac death.

http://ddfv.ufv.es/bitstream/10641/1239/1/CARTA%20CARDIOCOMPRESORES%20MECANICOS_english.pdf

Mechanical chest compression devices improve survival of liver grafts from donors after cardiac death.

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