Perforación cardiaca tardía tras el cierre percutáneo de un foramen oval permeable / Late cardiac perforation following percutaneous sealing of a permeable foramen ovale

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Protocolo de donación tras la muerte cardiaca controlada (donante tipo III de Maastricht). Experiencia inicial / Donation protocol following controlled cardiac death (Maastricht type III donation). First experience

OBJETIVO: Presentar la experiencia inicial con la implantación de un programa de donación tras la muerte cardiaca controlada en donantes tipo III de Maastricht. DISEÑO: Estudio retrospectivo, observacional y descriptivo. Ámbito: Unidad de cuidados intensivos de un hospital universitario terciario. PARTICIPANTES: Se evalúan 8 pacientes con enfermedad irreversible en los que se aplica la limitación de las técnicas de soporte vital y se consideran como potenciales donantes de órganos. INTERVENCIONES: Aplicación del protocolo presentado. Variables de interés: Características clínicas de los donantes, tipo de protocolo de donación aplicado, tiempos de isquemia caliente manejados y evolución a corto plazo de los receptores. RESULTADOS: Se incluyeron 8 pacientes. En uno de ellos se suspendió la donación al no fallecer en los 120min siguientes a la extubación terminal. Los 7 restantes fueron donantes renales efectivos. Los tiempos de isquemia caliente estuvieron siempre por debajo de los 23min. Los 14 receptores evolucionaron favorablemente; 7 de ellos presentaron retraso en la función del injerto pero en todos mejoró la función renal. CONCLUSIÓN: La donación tras la muerte cardiaca controlada en pacientes con enfermedad irreversible y catastrófica es una potencial fuente de donantes no considerada en nuestro país hasta el momento actual. Un programa previamente consensuado puede suponer un incremento en el número de órganos a los ya proporcionados por medio de la donación tras la muerte encefálica. Los resultados del trasplante renal en nuestra experiencia han sido buenos y el éxito de este tipo de programas podría extenderse al trasplante hepático y pulmonar

OBJECTIVE: To present our experience with the implementation of a donation protocol following controlled cardiac death (Maastricht type III donation). DESIGN: A retrospective descriptive and observational study was made. SETTING: Intensive Care Unit of a third-level university hospital. PATIENTS: Eight patients in an irreversible state, in which withdrawal of all life support had been agreed, were evaluated as potential donors. INTERVENTIONS: Application of the adopted protocol. Variables of interest: Clinical data of donors, evaluation of a donation protocol following cardiac death, warm ischemia times, and short-term outcome of the recipients. RESULTS: Eight patients were evaluated. In one case donation was not possible because no cardiac arrest developed in the 120minutes after extubation. The 7 remaining patients were effective kidney donors. Warm ischemia times were less than 23minutes in all cases. Although 7 of the 14 recipients suffered delayed graft function, all of them achieved good renal function. CONCLUSION: Donation after cardiac death in patients in an overwhelming and irreversible state represents a potential source of donors not previously considered in this country. The prior development of a consensus-based protocol can help increase the number of organs in combination with those obtained after brain death. In our experience, the results of kidney transplants obtained from donors after cardiac death are good, and the success of these types of protocols could be extended to other organs such as the liver and lungs

[Donation protocol following controlled cardiac death (Maastricht type III donation). First experience]. / Protocolo de donación tras la muerte cardiaca controlada (donante tipo iii de Maastricht). Experiencia inicial.

OBJECTIVE: To present our experience with the implementation of a donation protocol following controlled cardiac death (Maastricht type III donation). DESIGN: A retrospective descriptive and observational study was made. SETTING: Intensive Care Unit of a third-level university hospital. PATIENTS: Eight patients in an irreversible state, in which withdrawal of all life support had been agreed, were evaluated as potential donors. INTERVENTIONS: Application of the adopted protocol. VARIABLES OF INTEREST: Clinical data of donors, evaluation of a donation protocol following cardiac death, warm ischemia times, and short-term outcome of the recipients. RESULTS: Eight patients were evaluated. In one case donation was not possible because no cardiac arrest developed in the 120 minutes after extubation. The 7 remaining patients were effective kidney donors. Warm ischemia times were less than 23 minutes in all cases. Although 7 of the 14 recipients suffered delayed graft function, all of them achieved good renal function. CONCLUSION: Donation after cardiac death in patients in an overwhelming and irreversible state represents a potential source of donors not previously considered in this country. The prior development of a consensus-based protocol can help increase the number of organs in combination with those obtained after brain death. In our experience, the results of kidney transplants obtained from donors after cardiac death are good, and the success of these types of protocols could be extended to other organs such as the liver and lungs.