Donor after cardiac death kidney graft under mechanical cardiac compression evolution

Abstract

Mechanical chest compression (MCC) devices are routinely used in uncontrolled non-heart beating donors (NHBD), but findings are controversial. Although pulmonary parenchymal injuries have been detected, several studies have shown that injuries induced by MCC devices are similar to those induced by manual chest compressions.1Smekal D. Johansson J. Huzevka T. Rubertsson S. No difference in autopsy detected injuries in cardiac arrest patients treated with manual chest compressions compared with mechanical compressions with the LUCAS™ device – a pilot study.Resuscitation. 2009; 80: 1104-1107Abstract Full Text Full Text PDF PubMed Scopus (106) Google Scholar, 2Mateos Rodríguez A.A. Pascual J.M. Vallejo F.P. García A.P. Belmonte A.A. Lung injuries secondary to mechanical chest compressions.Resuscitation. 2012; 83: e203https://doi.org/10.1016/j.resuscitation.2012.03.040Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar According to previous results, the number of viable organs obtained by using such devices was lower than those obtained from donors not undergoing MCC.3Mateos Rodríguez A.A. Navalpotro Pascual M.J. Martín Maldonado M.E. Barba Alonso C. Pardillos Ferrer L. Andrés Belmonte A. Aplicación de cardiocompresores mecánicos en el donante tras una muerte cardiaca extrahospitalaria.Emergencias. 2010; 22: 264-268Google Scholar Subsequent studies have shown that the number of viable organs is similar4Carmona 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: 366-371Google Scholar and that the use of these devices facilitates the inclusion of more potential donors in the program.5Mateos Rodríguez A. Navalpotro Pascual J.M. Ortega I. et al.Traslado en helicóptero de donantes tras muerte cardiaca.Emergencias. 2011; 23: 372-374Google Scholar The objective of this study was to assess the medium-term renal function of kidney grafts obtained from NHBD undergoing MMC as compared with that of NHBD not undergoing MCC.Fifty cases (48 males) were included. The mean age was 35 (SD 11) in the non-MCC group and 49 (SD 11) in the MMC group, and a significant difference (p = 0.04) was found. MMC device was not used in 20 patients; 15 patients were treated by using the LUCAS© device and 12 by using the AutoPulse© device (data from the remaining 3 patients are not available).The average time from call to arrival into the scene was 13′35″ (SD 3′33″) in the non-MCC group and 11′19″ (SD 4′45″) in the MCC group. The time of arrival at hospital was 76′34″ (SD 20′29″) in the non-MCC group and 83′20″ (SD 21′41″) in the MMC group. Thus, no significant difference was found between times in the two groups.After six months, the non-MCC group showed an average creatinine level of 1.30 mg/dl as compared with 1.97 mg/dl in the MCC group. At 12 months, the figures were, respectively, 1.34 mg/dl and 1.88 mg/dl (Table 1). The creatinine level was slightly higher at 6 months and one year in the MCC group, but no significant difference between both groups was found. Although many variables play a role in the NHBD, we can conclude that the use of MCC devices does not produce significant changes in the renal function and, therefore, kidney grafts are perfectly valid for organ preservation in this procedure.Table 1Population's characteristics.Non-CCMCCMpAge (average ± SD)35 ± 1144 ± 110.04Sex: male (n)1038Arrival at scene time (min) (average ± SD)13′35″ ± 3′33″11′19″ ± 4′45″0.18Arrival at hospital time (min) (average ± SD)76′34″ ± 20′29″83′20″ ± 21′41″0.52Creatinine 6 months in mg/dl (average ± SD)1.30 ± 0.331.97 ± 2.140.3Creatinine 12 months in mg/dl (average ± SD)1.34 ± 0.321.88 ± 2.050.3 Open table in a new tab Conflict of interest statementNone declared. Mechanical chest compression (MCC) devices are routinely used in uncontrolled non-heart beating donors (NHBD), but findings are controversial. Although pulmonary parenchymal injuries have been detected, several studies have shown that injuries induced by MCC devices are similar to those induced by manual chest compressions.1Smekal D. Johansson J. Huzevka T. Rubertsson S. No difference in autopsy detected injuries in cardiac arrest patients treated with manual chest compressions compared with mechanical compressions with the LUCAS™ device – a pilot study.Resuscitation. 2009; 80: 1104-1107Abstract Full Text Full Text PDF PubMed Scopus (106) Google Scholar, 2Mateos Rodríguez A.A. Pascual J.M. Vallejo F.P. García A.P. Belmonte A.A. Lung injuries secondary to mechanical chest compressions.Resuscitation. 2012; 83: e203https://doi.org/10.1016/j.resuscitation.2012.03.040Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar According to previous results, the number of viable organs obtained by using such devices was lower than those obtained from donors not undergoing MCC.3Mateos Rodríguez A.A. Navalpotro Pascual M.J. Martín Maldonado M.E. Barba Alonso C. Pardillos Ferrer L. Andrés Belmonte A. Aplicación de cardiocompresores mecánicos en el donante tras una muerte cardiaca extrahospitalaria.Emergencias. 2010; 22: 264-268Google Scholar Subsequent studies have shown that the number of viable organs is similar4Carmona 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: 366-371Google Scholar and that the use of these devices facilitates the inclusion of more potential donors in the program.5Mateos Rodríguez A. Navalpotro Pascual J.M. Ortega I. et al.Traslado en helicóptero de donantes tras muerte cardiaca.Emergencias. 2011; 23: 372-374Google Scholar The objective of this study was to assess the medium-term renal function of kidney grafts obtained from NHBD undergoing MMC as compared with that of NHBD not undergoing MCC. Fifty cases (48 males) were included. The mean age was 35 (SD 11) in the non-MCC group and 49 (SD 11) in the MMC group, and a significant difference (p = 0.04) was found. MMC device was not used in 20 patients; 15 patients were treated by using the LUCAS© device and 12 by using the AutoPulse© device (data from the remaining 3 patients are not available). The average time from call to arrival into the scene was 13′35″ (SD 3′33″) in the non-MCC group and 11′19″ (SD 4′45″) in the MCC group. The time of arrival at hospital was 76′34″ (SD 20′29″) in the non-MCC group and 83′20″ (SD 21′41″) in the MMC group. Thus, no significant difference was found between times in the two groups. After six months, the non-MCC group showed an average creatinine level of 1.30 mg/dl as compared with 1.97 mg/dl in the MCC group. At 12 months, the figures were, respectively, 1.34 mg/dl and 1.88 mg/dl (Table 1). The creatinine level was slightly higher at 6 months and one year in the MCC group, but no significant difference between both groups was found. Although many variables play a role in the NHBD, we can conclude that the use of MCC devices does not produce significant changes in the renal function and, therefore, kidney grafts are perfectly valid for organ preservation in this procedure. Conflict of interest statementNone declared. None declared.