Pre-Mortem Percutaneous Femoral Venous Cannulation Significantly Reduces Blood Collection Time and Warm Ischemic Time in Donation after Circulatory Death Heart Procurement

Abstract

<h3>Purpose</h3> Successful collection of donor blood in donation after circulatory death (DCD) heart procurement when utilizing the TransMedics organ care system (OCS) is essential. This must be done expeditiously in order to minimize donor organ warm ischemic time as no flush can begin until the donor blood has been collected. This study investigated pre-mortem percutaneous femoral venous cannulation (PFVC) compared to post-mortem right atrial cannulation (RAC) to determine if there would be a reduction in time needed to collect donor blood as well as time to heart flush. <h3>Methods</h3> We compared time taken to collect 1,800 mL of donor blood and time to heart flush using post-mortem RAC and pre-mortem PFVC in DCD donors. With the RAC technique, the chest was entered expeditiously after the donor progressed and the right atrium was cannulated for donor blood collection. The PFVC technique utilized a femoral venous cannula placed percutaneously pre-mortem and clamped after the donor was systemically heparinized. Once the donor had progressed and procurement was allowed to begin, the cannula was unclamped and blood collection began immediately. The times from incision to completion of blood collection and to heart flush were recorded. <h3>Results</h3> A total of 8 donors were included in the study. Four donors were assigned to the RAC technique and 4 to the PFVC technique. The two groups were comparable based on age, gender and BMI. They also had similar values of hematocrit. Time to blood collection and time to heart flush were significantly decreased by approximately 110 seconds each in the femoral cannulation group (Table 1). <h3>Conclusion</h3> Our preliminary data shows that utilization of PFVC in DCD heart procurement significantly reduced time needed to collect the blood volume required as well as reduction in time to heart flush (warm ischemic time). This technique also allowed for immediate decompression of the heart and made prompt entry into the chest easier and safer.