Program of Uncontrolled Donation After Circulatory Death as Potential Solution to the Shortage of Organs: A Canadian Single-Center Retrospective Cohort Study.

Purpose: Worldwide, the number of patients waiting for organ transplantation exceeds the number of organs available. Program for uncontrolled donation after circulatory death (uDCD) implemented in Europe has resulted in a 10-15% expansion of the donor pool. We aimed to describe the number of patients eligible for an uDCD program in a regional tertiary care center. Methods: We conducted a retrospective cohort study in a Canadian tertiary academic center located in a rural area including all adults who received cardiopulmonary resuscitation in 2016 and died in the emergency department (ED) or during their hospitalization. The primary outcome was the number of patients eligible for uDCD defined as aged between 18 and 60 years old whose collapse was witnessed and where the time between cardiac arrest to cardiopulmonary resuscitation and ED arrival was, respectively, less than 30 and 120 minutes. As a secondary outcome, we determined the number of patients eligible for controlled donation after circulatory death. Results: Of the 130 patients included, 84 did not return to spontaneous circulation. We identified 15 potential uDCD candidates, with a mean age of 46.6 (95% Confidence Interval [CI] 41.3 to 52) years. Twelve had an out-of-hospital cardiac arrest with a mean time between collapse and arrival to the ED of 43.2 (29.8 to 56.6) minutes. Among the 46 patients who died after a return of spontaneous circulation, 10 (21.7%) were eligible for organ donation after circulatory death. Conclusion: Implementing an uDCD program in a tertiary hospital covering a rural area could increase the number of donors.

Nodding syndrome: bridging the gap-a scoping review protocol.

INTRODUCTION: Nodding syndrome (NS) is an encephalopathy of unknown origin that affects children aged between 3 and 15 years old. Cases have been reported since the 1950 in Tanzania and South Sudan, the most heavily affected population is the Acholi community in Uganda. In response to the high incidence of the disease, the Ugandan Government has developed a management algorithm, but access to such measures in affected communities is limited. There is little funding for research on the disease, consequently, few studies have been conducted to date. Nevertheless, the number of scientific publications on NS has increased since 2013, reporting several aetiological hypotheses, management algorithms and cases of stigmatisation; however, none has obtained conclusive results.This document describes a protocol for a scoping review of NS to date aimed at obtaining a broad overview of the disease. The results will identify gaps in knowledge in order to better guide future research, intervention strategies, health policies in areas at risk and cooperation and development programmes. METHODS AND ANALYSIS: To identify the relevant data, we will conduct a literature search using the electronic databases PubMed/Medline, Embase, Social Science Citation Index Scopus, Scientific Electronic Library Online (SciELO), Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Social Science Citation Index Expanded and The Cochrane Library. We will also include grey literature. The search strategy will be designed by a librarian.Two members of the team will work independently to identify studies for inclusion and perform data extraction. The search results will be assessed by two independent reviewers and data from the included studies will be charted and summarised in duplicate. The data will be summarised in tables and figures to present the research landscape and describe and map gaps. ETHICS AND DISSEMINATION: Ethical approval is not required. The scoping review will adhere to the Preferred Reporting Items for Systematic Reviews andMeta-Analyses-ScR guidelines. The results will be disseminated at scientific congresses and meetings.

Uncontrolled DCD: When Should We Stop Trying to Save the Patient and Focus on Saving the Organs?

Uncontrolled donation after circulatory death, which occurs when an individual has experienced unexpected cardiac arrest, usually not in a hospital, generates both excitement and concern. On the one hand, uDCD programs have the capacity to significantly increase organ donation rates, with good transplant outcomes-mainly for kidneys, but also for livers and lungs. On the other hand, uDCD raises a number of ethical challenges. In this essay, we focus on an issue that is central to all uDCD protocols: When should we cease resuscitation and shift to organ preservation? Do current uDCD protocols prematurely consider as potential donors patients who could still have some chances of meaningful survival? Can the best interest of patients be fostered once they are considered and treated as potential donors?

Extracorporeal Cardiopulmonary Resuscitation for Refractory Out-of-Hospital Cardiac Arrest: The State of the Evidence and Framework for Application.

Out-of-hospital cardiac arrest (OHCA) affects 134 per 100,000 citizens annually. Extracorporeal cardiopulmonary resuscitation (ECPR), providing mechanical circulatory support, may improve the likelihood of survival among those with refractory OHCA. Compared with in-hospital ECPR candidates, those in the out-of-hospital setting tend to be sudden unexpected arrests in younger and healthier patients. The aims of this review were to summarize, and identify the limitations of, the evidence evaluating ECPR for OHCA, and to provide an approach for ECPR program application. Although there are many descriptions of ECPR-treated cohorts, we identified a paucity of robust data showing ECPR effectiveness compared with conventional resuscitation. However, it is highly likely that ECPR, provided after a prolonged attempt with conventional resuscitation, does benefit select patient populations compared with conventional resuscitation alone. Although reliable data showing the optimal patient selection criteria for ECPR are lacking, most implementations sought young previously healthy patients with rapid high-quality cardiopulmonary resuscitation. Carefully planned development of ECPR programs, in high-performing emergency medical systems at experienced extracorporeal membrane oxygenation centres, may be reasonable as part of systematic efforts to determine ECPR effectiveness and globally improve care. Protocol evaluation requires regional-level assessment, examining the incremental benefit of survival compared with standard care, while accounting for resource utilization.

Extracorporeal resuscitation for refractory out-of-hospital cardiac arrest in adults: A systematic review of international practices and outcomes.

AIM: Extracorporeal resuscitation during cardiopulmonary resuscitation (ECPR) deploys rapid cardiopulmonary bypass to sustain oxygenated circulation until the return of spontaneous circulation (ROSC). The purpose of this systematic review is to address the defining elements and outcomes (quality survival and organ donation) of currently active protocols for ECPR in refractory out-of-hospital cardiac arrest (OHCA) of cardiac origin in adult patients. The results may inform policy and practices for ECPR and help clarify the corrresponding intersection with deceased organ donation. METHODS: We searched Medline, Embase, Cochrane and seven other electronic databases from 2005 to 2015, with no language restrictions. Internal validity and the quality of the studies reporting outcomes and guidelines were assessed. The review was included in the international prospective register of systematic reviews (Prospero, CRD42014015259). RESULTS: One guideline and 20 outcome studies were analyzed. Half of the studies were prospective observational studies assessed to be of fair to good methodological quality. The remainder were retrospective cohorts, case series, and case studies. Ages ranged from 16 to 75 years and initial shockable cardiac rhythms, witnessed events, and a reversible primary cause of cardiac arrest were considered favorable prognostic factors. CPR duration and time to hospital cannulation varied considerably. Coronary revascularization, hemodynamic interventions and targeted temperature management neuroprotection were variable. A total of 833 patients receiving this ECPR approach had an overall reported survival rate of 22%, including 13% with good neurological recovery. Additionally, 88 potential and 17 actual deceased organ donors were identified among the non-survivor population in 8 out of 20 included studies. Study heterogeneity precluded a meta-analysis preventing any meaningful comparison between protocols, interventions and outcomes. CONCLUSIONS: ECPR is feasible for refractory OHCA of cardiac origin in adult patients. It may enable neurologically good survival in selected patients, who practically have no other alternative in order to save their lives with quality of life, and contribute to organ donation in those who die. Large, prospective studies are required to clarify patient selection, modifiable outcome variables, risk-benefit and cost-effectiveness.

Protocols for uncontrolled donation after circulatory death: a systematic review of international guidelines, practices and transplant outcomes.

INTRODUCTION: A chronic shortage of organs remains the main factor limiting organ transplantation. Many countries have explored the option of uncontrolled donation after circulatory death (uDCD) in order to expand the donor pool. Little is known regarding the variability of practices and outcomes between existing protocols. This systematic review addresses this knowledge gap informing policy makers, researchers, and clinicians for future protocol implementation. METHODS: We searched MEDLINE, EMBASE, and Google Scholar electronic databases from 2005 to March 2015 as well as the reference lists of selected studies, abstracts, unpublished reports, personal libraries, professional organization reports, and government agency statements on uDCD. We contacted leading authors and organizations to request their protocols and guidelines. Two reviewers extracted main variables. In studies reporting transplant outcomes, we added type, quantity, quality of organs procured, and complications reported. Internal validity and the quality of the studies reporting outcomes were assessed, as were the methodological rigour and transparency in which a guideline was developed. The review was included in the international prospective register of systematic reviews (Prospero, CRD42014015258). RESULTS: Six guidelines and 18 outcome studies were analysed. The six guidelines are based on limited evidence and major differences exist between them at each step of the uDCD process. The outcome studies report good results for kidney, liver, and lung transplantation with high discard rates for livers. CONCLUSIONS: Despite procedural, medical, economic, legal, and ethical challenges, the uDCD strategy is a viable option for increasing the organ donation pool. Variations in practice and heterogeneity of outcomes preclude a meta-analysis and prevented the linking of outcomes to specific uDCD protocols. Further standardization of protocols and outcomes is required, as is further research into the role of extracorporeal resuscitation and other novel therapies for treatment of some refractory cardiac arrest. It is essential to ensure the maintenance of trust in uDCD programs by health professionals and the public.

Donación de órganos tras muerte inesperada por criterios circulatorios / Organ Donation after unexpected death determined by circulatory criteria

Objetivos: analizar los programas de uDCDD (uncontroller Donorsalter Circulatoty Determination of Death), que han sufrido modificaciones en sus nomenclaturas y definiciones, explorándolas posibles causas. Revisar las recomendaciones internacionales sobre los programas de uDCDD y las cláusulas emanadas de la Conferencia de Maastricht, para verificar el nivel de seguimiento por los programas de uDCDD activos en España, Francia y Estados Unidos. Analizar las modificaciones propuestas para que dichos programas sean acordes a los conocimientos científicos, al buen hacer profesional, a la ética ya la legislación, respetando el espíritu y los principios consensuados internacionalmente en materia de donación de órganos. Metodología: revisión bibliográfica referente a las actuales recomendaciones en reanimación centrada en el manejo de las paradas cardiorrespiratoria (PCR) de causa potencialmente reversible, identificando las técnicas y tratamientos que se están empleando de forma internacional. Se utilizaron las bases de datos: PubMed, CINAHL, CUIDEN y Biblioteca Cochrane. Se incluyeron artículos en inglés, francés y español hasta 2012.Se sistematizaron las variables: perfil de pacientes que se beneficia de las medidas no convencionales de RCP, técnicas y tratamientos aplicados y porcentaje de supervivencia sin déficit neurológico (Cerebral Peformance Categrories Scale,CPC). Asimismo, se efectuó una revisión de los programas de (..) (AU)

Objectives: to analyze programs for uDCDD (Uncontrolled Donation after Cardiac Determination of Death), which have undergone modifications in their nomenclatures and definitions, exploring their likely causes. To review international recommendations about uDCDD programs, and clauses issued by the Maastricht Conference, in order to assess their level of enforcement by uDCDD programs active in Spain, France and the United States. To analyze those modifications put forward so that said programs are in accordance with scientific knowledge, good professional practice, ethics and legislation, while respecting the spirit and the principles reached by international consensus regarding organ donations. Methodology: bibliographic review regarding current recommendations on resuscitation, focused on management of cardiorespiratory arrest (CRA) with a potentially reversible cause, identifying those techniques and treatments which are being used at an international level. The following databases were used: PubMed, CINAHL, CUIDEN and Cochrane Library. Their view included articles in English, French and Spanish until2012. The following variables were systematized: patient profile which benefits with non-conventional CRA measures, techniques and treatments implemented, and rate of survival without neurological deficit (Cerebral Performance Categories Scale,CPC). At the same time, a review was conducted for uDCDD programs in Spain, France and the United States, analyzing these (..) (AU)

Dispositivos técnicos en la asistencia a pacientes críticos en emergencias extrahospitalarias / Technical devices in the medical care of critical patients in extra-hospital emergencies

En el presente artículo se analizan las ventajas que en la práctica asistencial de la Enfermería de emergencias aportan cuatro dispositivos en aras de conseguir unos estándares de calidad inimaginables hace una década. La evidencia científica y la excelencia profesional se dan la mano en el manejo del paciente crítico. Así, en escenarios en los que se precisa un Soporte Vital Avanzado (SVA), los cardiocompresores torácicos, dispositivos de punción intraósea, bombas de infusión de emergenciacompactas y dispositivos facilitadores de la visualización vascular en la canalización de vías venosas periféricas, aportan una inestimable ayuda que viene a facilitar de forma evidente la labor del profesional enfermero en el ámbito de la emergencia prehospitalaria. Cabe esperar una presencia cada vez más generalizada de los cuatro dispositivos descritos, independientemente del modelo de que se trate, en el manejo del paciente crítico por parte de los profesionales de Enfermería, tanto de forma autónoma como de forma multidisciplinar (AU)

The present paper analyses the advantages that four devices provide in emergency nursing practice with a view to achieve quality standards that were unimaginable ten years ago. Scientific evidence and professional excellence go hand in hand in the management of the critical patient. Hence, in scenarios in which advance life support (ALS) is required, thoracic cardiocompressors, intraosseous access devices, compact emergency infusion pumps and devices that facilitate vascular visualization in peripheral vein canalisation, are of invaluable help as theyclearly facilitate the work of the nursing professional in the field of extrahospital and prehospital emergency care. A more and more generalized presence of the four mentioned devices, regardless of the modelin question, can be expected in the management of the critical patient by the nursing professional, both autonomously as in a multidisciplinary manner (AU)