Subject(s)
Humans , Male , Female , Middle Aged , Aged , Public-Private Sector Partnerships , Tissue and Organ Procurement , Tissue Donors , Retrospective Studies , SpainABSTRACT
No disponible
Subject(s)
Humans , Cerebral Arteries , Brain Ischemia , Brain Death , Ultrasonography, DopplerSubject(s)
Cerebrovascular Circulation , Heart Arrest , Arteries , Brain , Humans , Hypothermia, InducedABSTRACT
No disponible
Subject(s)
Humans , Tissue and Organ Procurement/organization & administration , Ethics, Institutional , Critical Care/organization & administration , Intensive Care Units/organization & administrationABSTRACT
BACKGROUND: Non-heart-beating donation (NHBD) is a useful way to obtain organs and tissues. Therefore, since 2012 we have had an NHBD protocol in the metropolitan area of Seville. The aim of this work was to present the results obtained after 3 years of program. METHODS: Prospective observational study carried out from 2012 to 2014. We included all patients with an extrahospitalary sudden death who did not survive despite cardiopulmonary resuscitation, becoming a potential donors (PD). Variables included number of consultations, PD, allowed donor (AD), real donor (RD), and family or legal refusals; minutes of out-hospital care, in-hospital care, cannulation, and perfusion of the RD; and number of organs and tissues removed and viable proportion. Nonallowed donors were grouped according to the discarding cause. RESULTS: We received 97 consultations, of which 40 were performed as PD. Of these, 24 were AD (60%) and 22 RD (55%). There were only 2 family refusals. In 2012, 10 patients were donors, 5 in 2013, and 7 in 2014. The out-hospital median time was 71 (interquartile range [IQR] 60-76) minutes, in-hospital 29 (26-34) minutes, cannulation 28 (24-33) minutes, and perfusion 135 (105-177) minutes. Eighteen tissues and 43 organs were extracted, of which 32 were implanted (75%), with kidneys (96%) being more frequent. Nonallowed donors numbered 12 in 2012, 4 in 2013, and 1 in 2014, and out-hospital causes were the most frequent discard reason. CONCLUSIONS: NHBD is a useful program in our city with a low refusal rate (8%), an average of 1.45 organs per donor, and kidney the most frequent organ.
Subject(s)
Death, Sudden , Donor Selection/methods , Heart Arrest , Organ Transplantation/statistics & numerical data , Tissue Donors/supply & distribution , Adult , Catheterization/statistics & numerical data , Female , Hospitals , Humans , Kidney , Male , Middle Aged , Perfusion/statistics & numerical data , Program Evaluation , Prospective Studies , Spain , Time FactorsABSTRACT
In recent years, the donation process is being characterized by a decreased number of brain deaths and a logistical shift toward cardiac-death donation, both controlled and uncontrolled, in Spain. As we know, cardiac-death donors produce fewer usable organs than brain-death donors. Therefore, many of the Spanish transplant coordinators are working to find new strategies that bring efficiency to donor detection. Since 2012, at the Virgen del Rocío University Hospital, Seville, we have been trying to obtain more donors with the use of a huge logistical and administrative effort of all the elements that make up the donation and transplantation teams, because we have sought to get organ donors in all private clinics in the city. The result of this effort has succeeded in increasing the donation rate in Seville to 3 donors and >6 usable organs per year. This paper also analyzes the characteristics of these donors, comparing our results with our community and the country. The conclusion of all this, we believe, encourages persevering in those efforts and endorses a strategy that could be applied in other parts of the world with good results in terms of transplanted organs.
Subject(s)
Private Practice , Tissue Donors/supply & distribution , Tissue and Organ Procurement/methods , Aged , Brain Death , Cause of Death , Female , Humans , Male , Prospective Studies , Spain , Transplants/supply & distributionABSTRACT
No disponible
Subject(s)
Humans , Brain Death/physiopathology , Postmortem Changes , Movement/physiology , Muscle Contraction/physiologySubject(s)
Brain Death/physiopathology , Movement , Humans , Nervous System/physiopathology , Reflex/physiologyABSTRACT
OBJETIVO: Evaluar si un modelo experimental de lesiones tipo masa (LM) transitoria en rata produce la liberación precoz a sangre periférica de enolasa neuroespecífica (NSE) y proteínaS100B como expresión del daño cerebral inducido. DISEÑO: Estudio experimental con grupo control. Ámbito: Quirófano experimental del Instituto de Biomedicina (IBiS) del Hospital Universitario Virgen del Rocío. PARTICIPANTES: Catorce ratas adultas Wistar. INTERVENCIONES: Se extrajo muestra sanguínea basal y posteriormente se realizó: grupo LM, através de un trépano, se infló el globo de una sonda con 500 _L/20 s; posteriormente, se realizaron4 extracciones sanguíneas cada 20 min. Grupo control, se repitieron de forma sistemática todos los pasos salvo que no se realizo trépano. Variables de interés principal: Peso, mortalidad precoz, concentración en suero de NSE yS100B.RESULTADOS: Encontramos diferencias entre las concentraciones de NSE y S100B a lo largo del tiempo dentro del propio grupo LM (p < 0,001), no sucediendo este hecho en el grupo control. Excepto en la determinación basal, encontramos diferencias en los valores medios de NSE yS100B entre ambos grupos. Tras el daño cerebral, la NSE y la S100B presentaron un incremento progresivo en el tiempo en todas las determinaciones realizadas con una r = 0,765; p = 0,001,y r = 0,628; p = 0,001, respectivamente. Por contra, en el grupo control no encontramos dicha correlación para ninguno de los dos biomarcadores. CONCLUSIONES: Las concentraciones en suero de NSE y S100B reflejan de forma precoz el daño cerebral que acontece sobre la sustancia gris y blanca en un modelo experimental de LM en rata
OBJECTIVE: To determine whether a model of transient mass-type brain damage (MTBD) in the rat produces early release of neurospecific enolase (NSE) and protein S100B in peripheral blood, as an expression of the induced brain injury. DESIGN: An experimental study with a control group. SETTING: Experimental operating room of the Institute of Biomedicine (IBiS) of Virgen del Rocío University Hospital (Seville, Spain).PARTICIPANTS: Fourteen adult Wistar rats. INTERVENTIONS: Blood was sampled at baseline, followed by: MTBD group, a trephine perforation was used to insert and inflate the balloon of a catheter at a rate of 500 _l/20 sec, followed by 4blood extractions every 20 min. Control group, the same procedure as before was carried out, though without trephine perforation. Primary study variables: Weight, early mortality, serum NSE and S100B concentration. RESULTS: Differences in NSE and S100B concentration were observed over time within the MTB Dgroup (P < .001), though not so in the control group. With the exception of the baseline determination, differences were observed between the two groups in terms of the mean NSE andS100B values. Following MTBD, NSE and S100B progressively increased at all measurement timepoints, with r = 0.765; P = .001 and r = 0.628; P = .001, respectively. In contrast, the control group showed no such correlation for either biomarker. CONCLUSIONS: Serum NSE and S100B concentrations offer an early indication of brain injury affecting the gray and white matter in an experimental model of mass-type MTBD in the rat
Subject(s)
Animals , Rats , Phosphopyruvate Hydratase/analysis , S100 Proteins/analysis , Brain Injuries, Traumatic/physiopathology , Disease Models, Animal , Case-Control StudiesABSTRACT
OBJECTIVE: To determine whether a model of transient mass-type brain damage (MTBD) in the rat produces early release of neurospecific enolase (NSE) and protein S100B in peripheral blood, as an expression of the induced brain injury. DESIGN: An experimental study with a control group. SETTING: Experimental operating room of the Institute of Biomedicine (IBiS) of Virgen del Rocío University Hospital (Seville, Spain). PARTICIPANTS: Fourteen adult Wistar rats. INTERVENTIONS: Blood was sampled at baseline, followed by: MTBD group, a trephine perforation was used to insert and inflate the balloon of a catheter at a rate of 500 µl/20 sec, followed by 4 blood extractions every 20 min. Control group, the same procedure as before was carried out, though without trephine perforation. PRIMARY STUDY VARIABLES: Weight, early mortality, serum NSE and S100B concentration. RESULTS: Differences in NSE and S100B concentration were observed over time within the MTBD group (P<.001), though not so in the control group. With the exception of the baseline determination, differences were observed between the two groups in terms of the mean NSE and S100B values. Following MTBD, NSE and S100B progressively increased at all measurement timepoints, with r=0.765; P=.001 and r=0.628; P=.001, respectively. In contrast, the control group showed no such correlation for either biomarker. CONCLUSIONS: Serum NSE and S100B concentrations offer an early indication of brain injury affecting the gray and white matter in an experimental model of mass-type MTBD in the rat.
Subject(s)
Brain Injuries/blood , Phosphopyruvate Hydratase/blood , S100 Calcium Binding Protein beta Subunit/blood , Animals , Disease Models, Animal , Male , Rats , Rats, WistarABSTRACT
OBJECTIVE: The objective of this study is to assess the S100B protein serum concentrations from brain dead (BD) donors to understand whether its level could provide clinical information during BD diagnosis as a potential confirmatory test. METHODS: During 12 months, 26 patients declared BD were prospectively included in this study. Once the diagnosis of BD was achieved, serum S100B protein levels were measured using an electrochemiluminescence assay. For analytical purposes, we selected the maximum S100B serum value reached during the first 5 days of evolution from a historical cohort of 124 survived patients after a severe brain injury (SBI), as well as from 18 healthy donors (HD) and a subgroup of patients who had severe traumatic brain injuries (TBIs) without extracranial injuries. RESULTS: Mean age was 53.48 years (SD, 18.91 years). The BD group had significantly higher S100B serum levels (1.44 µg/L; interquartile ratio [IR], 0.63-3.68) than the SBI (0.34 µg/L; IR, 0.21-0.60) and HD groups (0.06 µg/L; IR, 0.03-0.07; P < .001). Analysis of S100B levels depending on the main cause responsible for BD development showed significant differences between subgroups (P = .012). S100B serum levels were higher in the isolated TBI BD group (P = .004). The S100B value showed an odds ratio for BD diagnosis of 8.38 (95% confidence interval [CI], 1.16-60.45; P = .035). Reciever operating characteristic analysis revealed an area under the curve of 0.92 (95% CI, 0.79-1.00; P = .007). We set a cut-off value of 2 µg/L in S100B serum concentrations. At this level, the diagnostic properties of S100B would reach 100% of specificity and positive predictive value (PPV), and sensitivity and negative predictive value (NPV) of 60% and 86.7%, respectively. CONCLUSION: This preliminary analysis shows for the very first time that BD is associated with higher S100B serum levels, compared with other neurocritical care patients. We also found that the cause of BD development must be considered. Specifically, S100B serum levels in severe isolated TBI patients-with clinical exploration compatible with BD-could be used in a future as confirmatory test.
