Timing of heparin and perfusion temperature during procurement of organs with extracorporeal support in donors after circulatory determination of death

Alvaro Rojas-Pena, Candice M. Hall, Keith E. Cook, Robert H. Bartlett, Juan D. Arenas, Jeffrey D. Punch

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Despite successful resuscitation of donors after circulatory determination of death (DCD) with extracorporeal support (ECS), the technique is limited by ethical concerns about donor management (heparinization) and the complexity to operate the ECS circuit. This work studies different timing of heparin administration and the effects of ECS-perfusion temperature. Cardiac arrest (CA) was induced in swine. Heparin studies, three groups: 1) PRE5, heparin 5 minutes before CA; 2) POST5, heparin 5 minutes after CA, plus 2 minutes external chest compressions; and 3) POST30, heparin with the initiation of ECS after 30 minutes CA. Perfusion temperature study, two groups: 1) normothermic, ECS-38.5°C after 30 minutes CA and 2) room temperature, ECS-25.5°C for the first 90 minutes, followed by ECS-38.5°C. Heparin studies: ECS target flows (>50 ml/kg/min) were not achieved in the POST30 group, affecting local organ perfusion as observed with poor bile (<4 ml/min) and urine output (<25 ml/min), when compared with the other groups (normal values). Temperature study: In both groups, ECS target flows were reached, and urine/bile output was restored. Heparinization 5 minutes after CA is equivalent to premortem heparinization in this ECS-DCD model. Heparinization after CA could reduce ethical concerns. Donors after circulatory determination of death were successfully resuscitated at both temperatures, suggesting that the heat exchanger/water heater can be removed to simplify the ECS circuit.

Original languageEnglish (US)
Pages (from-to)368-374
Number of pages7
JournalASAIO Journal
Volume57
Issue number5
DOIs
StatePublished - Sep 2011

Fingerprint

Tissue and Organ Procurement
Heart Arrest
Heparin
Perfusion
Temperature
Bile
Urine
Resuscitation
Water heaters
Induced Heart Arrest
Networks (circuits)
Heat exchangers
Reference Values
Swine
Thorax
Hot Temperature
Water

ASJC Scopus subject areas

  • Biophysics
  • Biomaterials
  • Bioengineering
  • Biomedical Engineering
  • Medicine(all)

Cite this

Timing of heparin and perfusion temperature during procurement of organs with extracorporeal support in donors after circulatory determination of death. / Rojas-Pena, Alvaro; Hall, Candice M.; Cook, Keith E.; Bartlett, Robert H.; Arenas, Juan D.; Punch, Jeffrey D.

In: ASAIO Journal, Vol. 57, No. 5, 09.2011, p. 368-374.

Research output: Contribution to journalArticle

Rojas-Pena, Alvaro ; Hall, Candice M. ; Cook, Keith E. ; Bartlett, Robert H. ; Arenas, Juan D. ; Punch, Jeffrey D. / Timing of heparin and perfusion temperature during procurement of organs with extracorporeal support in donors after circulatory determination of death. In: ASAIO Journal. 2011 ; Vol. 57, No. 5. pp. 368-374.
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