Rewarming Time Research Articles

Thromboelastography-guided Intraoperative Platelet Transfusion in Pediatric Heart Surgery

BackgroundPostoperative bleeding is associated with significant resource use and is an important contributor to other major adverse events in pediatric patients undergoing complex cardiac surgical procedures. Thromboelastography (TEG; TEG 6S, Haemonetics) can guide perioperative blood product transfusions to reduce the risk of postoperative bleeding. This study validated the use of a previously developed TEG 6S maximum amplitude (TEG-MA)–based platelet transfusion calculator used during cardiac surgical procedures to minimize the risk of postoperative bleeding. MethodsIn this single-center retrospective study of pediatric patients (aged ≤18 years) who underwent cardiac surgical procedures requiring cardiopulmonary bypass at Boston Children’s Hospital (Boston, MA) (N = 1000), the volume of platelet transfusion administered at surgical team discretion was compared with the platelet calculator–recommended platelet transfusion volume by using linear regression analysis. Associations between the adequacy of perioperative platelet transfusion and postoperative bleeding or thrombotic complications within the first 24 hours postoperatively (bleeding) and until hospital discharge (thrombosis) were evaluated by logistic regression analysis. ResultsLower TEG-MA (≤45 mm) measurements after transfusion were associated with a higher risk for postoperative bleeding (odds ratio, 4.4; 95% CI, 2.6-7.4; P < .01 [significant P value <.05]). The platelet transfusion calculator–recommended platelet transfusion volume (on the basis of TEG-MA measured at the time of rewarming) demonstrated moderate correlation with the measured TEG-MA value after platelet transfusion (Pearson r = 0.7). Intraoperative volumes of platelet transfusion that failed to increase a postoperative TEG-MA of at least 45 mm significantly increased the risk for postoperative bleeding in the first 24 hours after surgical procedures (odds ratio, 3.2; 95% CI, 1.9-5.4; P < .01 [significant P value <.05]). The posttransfusion TEG-MA was not independently associated with thrombosis. ConclusionsCustomizing perioperative platelet transfusion therapy by using quantitative diagnostic tests can help reduce postoperative bleeding complications.

Hand cold stress testing among Arctic open-pit miners: a clinical study

Objectives. This study aimed to evaluate the influence of individual characteristics (sex, age, body mass index [BMI] and smoking habits) on the tolerance time, pain ratings and rewarming time of hand cold stress testing (CST). Methods. We included 153 subjects (63% men) working in a Swedish open-pit mine (participation rate 41%). The right hand was immersed in 3 °C circulating water for up to 45 s. Pain ratings were registered every fifth second using a visual analog scale. Results. The tolerance time (mean ± standard deviation) was 35 ± 12 s for men and 29 ± 14 s for women (p = 0.007). The youngest age group (18–29 years) had the longest tolerance time, while the oldest group (54–65 years) had the shortest (p = 0.005). Women had significantly higher pain ratings than men after 5, 10 and 25 s. The group with the highest BMI had the shortest rewarming time (p < 0.001). Conclusions. Age and sex influenced the tolerance time of hand CST, while only sex affected the pain ratings and BMI the rewarming time. When performing CST in future studies, these parameters should be considered.

Probing the Size Effect of Graphene Oxide Nanosheets on Ice Crystal Regulation and Laser-Assisted Rapid Rewarming.

Two-dimensional (2D) nanomaterials have attracted many researchers to explore the effect of ice control and rapid deicing due to their functional groups, large specific surface area, and excellent photothermal properties. However, the impact of size effects on ice crystal formation, growth, and photothermal performance has been rarely explored. Here, graphene oxide nanosheets (GO NSs) with controllable sizes were used as a representative of 2D nanomaterials to probe the effect of size on ice crystal regulation and rapid rewarming in cell cryopreservation. All sizes of GO NSs exhibited notable inhibitory effects on ice crystal size during the recrystallization process. Significantly, when the size of GO NSs was smaller than a certain size (<150 nm), they showed a more significant ice recrystallization suppression effects, which could reduce the ice crystal size to about 17% of that of pure water. Meanwhile, the photothermal experiments also indicated that smaller-sized GO NSs exhibited better photothermal behavior, with 90 nm GO NSs (GO-90) heating to 70 °C in just 1 min induced by an 808 nm laser (2 W/cm2). Furthermore, applying GO-90 (200 μg/mL) to cell cryopreservation, cell viability could reach 95.2% and 93% with a low amount of traditional cryoprotectant (2% v/v DMSO) for A549 cells and HeLa cells after recovery, respectively. With the assistance of a 808 nm laser, the rewarming time was also shortened to 20 s, greatly improving the rewarming rate. Our work associated specific sizes of 2D nanomaterials with their ice growth inhibition behaviors during recrystallization and photothermal properties to synergistically improve cell cryopreservation efficiency, providing guidance for effectively designing novel 2D nanomaterials for collaborative control of ice crystals in cell cryopreservation.

P144 Extended examination of post-challenge rewarming in patients with systemic sclerosis, as assessed by thermography

Abstract Background/Aims Clinical trials of systemic sclerosis (SSc)-related Raynaud’s phenomenon require better objective outcome measures. Thermography-monitored cold-challenge is a validated imaging technique. Cold-challenge is monitored for 15-minutes during rewarming, however, patients often do not fully rewarm. Knowing rewarming time enables better planning of daily trial protocols (e.g. challenges before and after treatment). The aim of this study was to test the hypotheses that 15-minute rewarming measurements are predictive of two-hour rewarming and that patients rewarm within a two-hour period. Methods Baseline thermography of the hands and cold-challenge was performed (1 minute, 15oC water, gloved hands submerged). Post-cold challenge, images were taken every 15s (to 15 minutes), every 5 minutes (to 30 minutes), every 10 minutes (to 60 minutes) and every 15 minutes (to 120 minutes). Baseline finger temperature (average, eight fingers, Tbase) and distal dorsal difference (DDD, temperature difference between dorsum ofthe hand and distal finger) were calculated from baseline images. Mean finger temperature difference (post-cold challenge-baseline, Tdiff), time to 25% (t25%), 50% (t50%), 100% (t100%) rewarming, maximum temperature achieved (Tmax), time to Tmax (tmax), area under the rewarming curve (AUC), and final temperature (Tf) were calculated. Cox regression assessed associations between Tbase, Tmax, Tf, DDD and AUC. Results Twenty patients with SSc were recruited; median (interquartile range) age 62 (53-69), duration of RP 16 (7-26) years. Fourteen patients (70%) rewarmed within two hours. Data, Table 1. Cox regression showed positive relationship between AUC and t25%, t50% and t100% and a negative relationship between Tbase, t50% and t100%. In the non-rewarming subset, 3/6 and 1/6 achieved t25%, t50% in 15 minutes. 13/14 patients that rewarmed achieved t25% and 11/14 achieved t50% within 15 minutes. Results suggest that the likelihood of longer-term rewarming is predicted the initial 15-minute rewarming. Conclusion Tbase was reached by the majority of patients with SSc in a two-hour window, therefore, a second or third cold challenge could be incorporated into early Phase II study protocols within a study day. Patients reaching t50% within 15 minutes were highly likely to rewarm fully over two hours; thus 15-minute rewarming may aid screening to identify patients who will fully rewarm. Disclosure A. Ndosi: None. G. Dinsdale: None. J. Manning: None. M. Mandzuk: None. S. Wilkinson: None. A. Herrick: None. A. Murray: None.

Robotic kidney transplantation.

Kidney transplantation is the best treatment option for patients with end-stage renal disease owing to improved survival and quality of life compared with dialysis. The surgical approach to kidney transplantation has been somewhat stagnant in the past 50 years, with the open approach being the only available option. In this scenario, evidence of reduced surgery-related morbidity after the introduction of robotics into several surgical fields has induced surgeons to consider robot-assisted kidney transplantation (RAKT) as an alternative approach to these fragile and immunocompromised patients. Since 2014, when the RAKT technique was standardized thanks to the pioneering collaboration between the Vattikuti Urology Institute and the Medanta hospital (Vattikuti Urology Institute-Medanta), several centres worldwide implemented RAKT programmes, providing interesting results regarding the safety and feasibility of this procedure. However, RAKT is still considered an alternative procedure to be offered mainly in the living donor setting, owing to various possible drawbacks such as prolonged rewarming time, demanding learning curve, and difficulties in carrying out this procedure in challenging scenarios (such as patientswith obesity, severe atherosclerosis of the iliac vessels, deceased donor setting, or paediatric recipients). Nevertheless, the refinement of robotic platforms through the implementation of novel technologies as well as the encouraging results from multicentre collaborations under the umbrella of the European Association of Urology Robotic Urology Section are currently expanding the boundaries of RAKT, making this surgical procedure a real alternative to the open approach.

Minimally invasive recipient procedure in kidney transplantation.

There are several procedural variations for kidney transplant donors, including open, laparoscopic, hand-assisted, and robotic methods, with either an intra- abdominal or retroperitoneal approach. Conversely, fewer options are available for the recipient procedure. We introduce a method that involves a small incision, with the goal of being less invasive for recipients. Our current method was introduced in April 2022. As of July 2023, we have completed 27 cases. We analyzed several factors in these 27 cases, including the size of the incision, rewarming time, anastomosis time, graft function, analgesic use, and complications. The average incision size was 73 mm. The time taken for anastomosis was 24. 1 minutes, while the rewarming time averaged 43.1 minutes. There were no instances of primary nonfunction. One case necessitated postoperative dialysis three times due to heart failure. Following stent removal, one patient developed grade 1 hydronephrosis. There was one instance of bleeding from the drain insertion site. Another case involved a clamp injury to the external iliac artery, which necessitated stent insertion on the fourth postoperative day. Compared to procedures performed using conventional methods, the use of analgesics was less in these cases. Our minimally invasive technique, which involves a small incision, is a feasible alternative that could potentially be less invasive than traditional methods.

Reducing the Incidence of Postoperative Hypothermia in Patients Undergoing Robotic-Assisted Mitral Valve Surgery

Post-operation hypothermia tends to induce complications. Sixty percent of robotic-assisted mitral valve surgery patients experienced hypothermia while admitted to our intensive care unit (ICU), resulting in prolonged ICU stays and 57% (eight) of those patients with hypothermia also experiencing cardiac arrhythmia. The causes of hypothermia in our ICU included low temperature in the operating room, delayed initiation of blanket coverage after surgery, and lack of postoperative thermal blankets, insufficient cardiopulmonary bypass rewarming time, cold ICU beds, lack of in-service training for hypothermia, and lack of procedure auditing. This intervention was designed to reduce the incidence of hypothermia in ICU patients undergoing robotic-assisted mitral valve surgery upon ICU admission from 60% to 36% and the one-hour hypothermia rate from 43.3% to 26%. We implemented several measures including increasing the room temperature, pre-heating the ICU bed, achieving team consensus regarding prolonging the rewarming time after cardiopulmonary bypass, establishing a blanket warming area for postoperative patient use, and holding in-service training to enhance the awareness of the nurses were implemented. The incidence of hypothermia in ICU patients receiving robotic-assisted mitral valve surgery upon ICU admission decreased from 60% to 19.4%, while the one-hour hypothermia rate decreased from 43.3% to 19.4%. Using systemic interprofessional collaboration, combined thermal care can be achieved to significantly reduce the incidence of postoperative hypothermia in patients undergoing robotic-assisted mitral valve surgeries resulting in higher patient care quality and shorter ICU stays. We recommend applying this combined method to improve the quality of perioperative care for long-duration and major surgical procedures that involve large postoperative wounds and for patients who may require wider exposure during their operation.

Abstract 11084: Procedural Parameters During Cryoballoon Ablation Predict Early Pulmonary Vein Reconnection and Atrial Fibrillation Recurrence

Introduction: Cryoballoon ablation (CBA) is an established procedure for the management of atrial fibrillation (AF). We sought to assess procedural parameters as predictors of early PV reconnection and AF recurrence following CBA. Methods: 119 patients undergoing CBA for AF were included. Balloon temperature (BT) recorded by the console during CBA targeting each of the four pulmonary veins (PV) was monitored to determine the time needed to reach -15°C and -40°C from the start of the freeze. BT at 30 seconds (s), 60 s and the temperature nadir point were also recorded. Rewarming (thaw) time from the nadir point to 0 °C, was also determined. PVs were assessed for early reconnection and patients were followed for arrhythmia recurrence. Results: Early PV reconnection was identified in 39 (8.3%) of 471 PVs. BT was significantly colder in the absence of early PV reconnection (30 s: -33.5°C vs -29.5°C, p=0.001; 60 s: -41°C vs -36.5°C, p&lt;0.001; nadir: -47°C vs -41.5°C, p&lt;0.001). Early PV reconnection was associated with significantly shorter time to reach -15°C and -40°C (12s vs 14.5s, p=0.023; and 46s vs 75s, p=0.005) and longer rewarming time (7s vs 5.75s, p=0.012) (Panel A). A logistic regression model with the procedural parameters was created to predict early PV reconnection and the corresponding ROC analysis had an AUC=0.71 (Panel B). During an average follow-up period of 559 days, AF recurrence occurred in 51 (49%) patients. Kaplan Meier analysis showed better arrhythmia free survival for patients in whom BT decreased below -40°C in all PVs and patients who had no early PV reconnections, compared to patients where BT below -40°C was not achieved in at least one PV (Log Rank = 6.3, p=0.012) and patients who had PV reconnections (Log Rank = 4.1, p=0.043) (Panel C). Conclusions: Slower BT decline, warmer BT nadir, and faster rewarming time predict early PV reconnection. A lower rate of AF recurrence was associated with absence of early PV reconnections and achieving a BT below -40 °C in all PVs.

Abstract 204: Optic Nerve Sheath Diameter Trajectories During Targeted Temperature Management

Introduction: The extent of hypoxic-ischemic injury (HII) after cardiac arrest (CA) remains an important knowledge deficit with lack of objective clinical data that is measurable repeatedly. There is a need to better understand an individual patient’s level of HII. Optic nerve sheath diameter (ONSD) has not been explored after CA as a possible bedside modality to measure the extent of HII over time, at the bedside, during targeted temperature management (TTM). Objective: We sought to characterize the temporal trajectories of point-of-care ultrasound obtained ONSD during the post- return of spontaneous circulation (ROSC) phase, in patients with and without TTM. Methods: Adult CA patients at an urban academic ED were included from 2017-2021. ONSD was measured by emergency ultrasound fellowship trained faculty at 1, 6, 24, 48, and 72 hours after ROSC using an ocular preset on a 15MHz linear probe. ONSD measurements at these time points were compared with patient demographic information and intervention of TTM . Results: A total of 78 participants had ONSD measurements. The mean age was 62 (+/-15) and 46% were female. Of the 65% of the cases with TTM, a sex disparity was noted with 73% of males receiving TTM versus 56% of females. There was a trend toward a decrease in mean ONSD by 0.015cm for TTM patients during the early time points of 1 to 6 hours compared to an increase in 0.006cm in those without TTM. Similar trend was noted between 1 to 24 hours, with a decrease in ONSD by 0.025cm in those with TTM relative to an average increase of 0.008 cm in those without TTM. However, neither delta ONSD was statistically significant between the two cohorts. When further assessing if delay in cooling had an impact on ONSD change, we found that the ONSD change between 24 to 48 hours was significantly increased in those in whom TTM was not initiated within 14 hours (beta=0.036; p=0.016). Conclusion: This pilot study revealed ONSD changes during TTM. There is potential for monitoring brain injury through ONSD trajectories to evaluate responders vs non-responders to TTM. Additional research is needed to evaluate ONSD changes during the rewarming time frame and may further distinguish patients with worse HII. Correlation to survival outcomes can be possible with a larger sample size.

Robotic-Assisted Kidney Transplantation from Living Donors: Single Center Experience

Introduction: Robotic-assisted kidney transplantation (RAKT) is being adopted for renal transplantation in obese patients with ESRD. Methods: Consecutive RAKT procured via robotic live donor nephrectomy at our center between June 2018 and August 2021 were retrospectively analyzed. Our first 20 cases (Group I) were compared (student’s t-test and Fisher’s exact test, p < 0.05 significant) to the later 20 cases (Group II). Results: There was no difference in donor age (39.6±10.51 vs 38.4±12.14 years) or BMI (27.46±4.64 vs 29.48±4.06) between the two groups. 75% of recipients in both groups received a left kidney. A majority (>60%) of recipients in both groups were African Americans. Recipients in Group II were significantly older than in Group I. There was no significant difference in patient or graft survival or serum creatinine (1.67±0.99 mg/dL vs 1.93±0.55 mg/dL) at 1-year post-RAKT. One patient in group I died from respiratory failure due to COVID-19. The anastomosis times (35.16±7.75 vs 32.00±7.32 mins) were not significantly different, though the re-warming time was a significantly longer in our early experience (47.75±9.59 vs 42.00±6.55 mins, p = 0.016). The incidence of post-op washout (10%), ileus (10%), incisional hernia (5%) and delayed graft function (20%) were similar in both groups. Conclusion: Our early and more recent experience demonstrates that RAKT from living donors can be safely performed with excellent outcomes in obese, predominantly African American patients with ESRD. Practice paradigms are evolving to offer RAKT to patients with BMI >40 who may otherwise be considered ineligible for kidney transplantation.

In vitro PROPAGATION OF BANANA SHOOT TIPS AND CRYOPRESERVATION BY VITRIFICATION

Micropropagation of banana is limited as explants are difficult to maintain in culture. The present study was conducted to investigate different factors for banana cryopreservation. This study has two parts. In the first part of study in vitro propagation of banana was done to propagate large number of explants for cryopreservation. Whereas, in the second part, banana shoot tips were cryopreserved by vitrification technique. During this study, different parameters such as exposure to plant vitrification solution PVS2 and PVS3, rewarming time were optimized. For cryopreservation by vitrification method, shoot tips were precultured on solidified MS medium supplemented with 0.3 M sucrose for 16 h at 25C. Then they were loaded in loading solution containing 2M glycerol and 0.4 M sucrose for 30 minutes at room temperature. After loading step, shoot tips were dehydrated with plant vitrification solution (PVS2) and (PVS3) with different exposure times (10,30,40,60,90,120 min) respectively. The best result was obtained with shoot tips treated with PVS2 for 60 min and 120 minutes for PVS3 with survival rates of cryopreserved shoot tips as 85% and 33% respectively. Furthermore, effect of different rewarming times was also investigated on shoot tip viability. Among tested different rewarming times (0,2,4 and 6min), 2 min of rewarming time in PVS2 and 4 min of rewarming time in PVS3 were found suitable for cryopreservation as they retained survival rate as 97% and 75% respectively.

Thermographic Evaluation of the Duration of Skin Cooling After Cryotherapy in Dogs Following Tibial Plateau Leveling Osteotomy Surgery.

ObjectiveTo evaluate the duration of cooling after cryotherapy on the skin over stifle joints in dogs after tibial plateau leveling osteotomy (TPLO) surgery using thermography.Materials and MethodsSeventeen client-owned dogs of various breeds were enrolled in the study. Dogs underwent TPLO surgeries, and on the next day, thermal imaging was performed on the operated stifle prior to cryotherapy for baseline. Orthogonal views were repeated at 30-min intervals until the skin over the stifle had thermally equilibrated. An ice pack was applied for 20 min on the medial and lateral aspects of the stifle. Each stifle was then re-imaged every 15 min for the first 60 min then every 30 min subsequently until the temperature was within 1°C of the pre-cryotherapy temperature.ResultsMean skin temperature of the medial view showed no significance difference compared to baseline value at 45 min after cryotherapy was discontinued and after 60 min for the lateral and cranial views. Mean skin temperature was overall higher in the medial view compared to the lateral and cranial during the rewarming period (except immediately after cold application). Mean skin temperatures of all views combined showed a significant decrease in temperature during cryotherapy application, with a slow increase until a plateau was reached after 45 min of rewarming.Conclusions and Clinical RelevanceDogs undergoing TPLO for cranial cruciate ligament injury showed quicker rewarming period of superficial tissues compared to previous studies. Cryotherapy is a beneficial modality to reduce superficial tissue temperature in dogs undergoing TPLO, acknowledging that these dogs may require more frequent cryotherapy post-operatively due to more rapid rewarming time compared to dogs without surgery.

Living Donor Robot-Assisted Kidney Transplantation: a New Standard of Care?

Robot-assisted kidney transplantation (RAKT) has the potential to combine the advantages of minimally invasive surgery with the best renal replacement treatment. Over the last decade, the results were encouraging, as surgical and functional outcomes seem optimal in living donation. Recent studies focused on the comparison with open kidney transplantation (OKT), special situations such as obese patients or multiple vessels grafts and optimization of the technique to increase its surgical indications. Relative to OKT, RAKT has longer rewarming time and operative time, but lower intraoperative blood loss. Wound-related events and postoperative pain decrease with robotic technique. This has been also demonstrated in obese patients, where RAKT may be particularly beneficial. No significant difference was found in graft function, graft survival, and patient survival with RAKT and OKT in short- and mid-term follow-up. A multiple vessels graft should not be considered a contraindication to robotic surgery. Intracorporeal cooling systems for regional hypothermia have not been applied in RAKT yet. Future challenges will be the inclusion of patients with atheromatous iliac arteries and transplantation programs for deceased donors. A randomized-controlled trial is needed to definitively confirm the findings of retrospective and prospective cohort studies. The implementation of the procedure in more centers depends on broader indications, which might ultimately decrease procedure-related costs. To guarantee the applicability of RAKT from deceased donors, it is fundamental to optimize the graft cooling systems and to include recipients with atheromatous iliac arteries.

PD45-05 STEP-BY-STEP DEVELOPMENT OF A COLD ISCHEMIA DEVICE FOR OPEN AND ROBOT-ASSISTED RENAL TRANSPLANTATION

You have accessJournal of UrologyRenal Transplantation & Vascular Surgery II (PD45)1 Sep 2021PD45-05 STEP-BY-STEP DEVELOPMENT OF A COLD ISCHEMIA DEVICE FOR OPEN AND ROBOT-ASSISTED RENAL TRANSPLANTATION Angelo Territo, Matteo Fontana, Andrea Gallioli, Alberto Piana, Pietro Diana, José Maria Gaya, Jorge Huguet, Pavel Gavrilov, Oscar Rodriguez Faba, Alex Mottrie, Carme Facundo, Lluís Guirado, Joan Palou, and Alberto Breda Angelo TerritoAngelo Territo More articles by this author , Matteo FontanaMatteo Fontana More articles by this author , Andrea GallioliAndrea Gallioli More articles by this author , Alberto PianaAlberto Piana More articles by this author , Pietro DianaPietro Diana More articles by this author , José Maria GayaJosé Maria Gaya More articles by this author , Jorge HuguetJorge Huguet More articles by this author , Pavel GavrilovPavel Gavrilov More articles by this author , Oscar Rodriguez FabaOscar Rodriguez Faba More articles by this author , Alex MottrieAlex Mottrie More articles by this author , Carme FacundoCarme Facundo More articles by this author , Lluís GuiradoLluís Guirado More articles by this author , Joan PalouJoan Palou More articles by this author , and Alberto BredaAlberto Breda More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002059.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Rewarming time can be associated with delayed graft function (DGF) due to ischemia/reperfusion damage. In both open kidney transplantation (OKT) and robotic assisted kidney transplantation (RAKT), ice slush is used to maintain graft temperature (GT) (target <20°C), preventing its impairment due to the rewarming time. This cooling technique is not able to keep a constant, equal temperature over the entire graft surface and can potentially provoke local or systemic hypothermia. The aim of a cold ischemia device (CID) is to maintain a constant low temperature of the entire graft while performing vascular anastomosis. METHODS: In IDEAL phase 1, CID was developed with bioengineers from GRENA Ltd. It consists of 2 layers of a thin film sealed to create a circuit, through which saline could flow in a closed system thanks to silicone tubes connected to a peristaltic pump and saline reservoir. CID was tested in the dry lab to determine whether it could keep a kidney at a constant low temperature, using 15 porcine kidneys: in 5 the device was used (group 1), in 5 a gauze jacket filled with ice slush was used (group 2), and in 5 no covering was used (group 3). The three groups of kidneys were introduced into a closed box with a predetermined temperature of 37.5°C, simulating the temperature of the abdominal cavity (38°C). The temperature was evaluated at scheduled timepoints from T0 (baseline) to T11 (50th minute). In phase 2a, CID was evaluated in porcine model (in-vivo) undergoing OKT and RAKT. In phase 2b, CID was tested in patients undergoing OKT and RAKT from living donors, monitoring GT with a thermal probe. Surgical procedures were performed according to standard technique. RESULTS: In IDEAL phase 1, CID proved able to maintain a low GT (<20°C) and was superior to both the gauze jacket filled with ice slush and no covering (p=0.002). In IDEAL phase 2a, CID allowed maintenance of a low and constant GT during both OKT (n=3) and RAKT (n=3), with a mean temperature at T11 of 10.8°C (SD 0.2) and 14.9°C (SD 0.1), respectively. In IDEAL phase 2b, demonstrated that both OKT (n=2) and RAKT (n=3) can be performed using CID in a clinical setting. In both approaches, GT never exceeded 20°C, with mean temperatures of 15.7°C and 18.3°C in OKT and RAKT, respectively. In all 5 cases, surgical times using CID were similar to the conventional approach. All (n=5) patients were discharged at post-op day 7; no cases of DGF were recorded. CONCLUSIONS: CID showed to keep a constant low GT in both OKT and RAKT. In terms of maneuverability and feasibility, it allows to perform vascular anastomosis within a satisfactory length of time. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e744-e744 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Angelo Territo More articles by this author Matteo Fontana More articles by this author Andrea Gallioli More articles by this author Alberto Piana More articles by this author Pietro Diana More articles by this author José Maria Gaya More articles by this author Jorge Huguet More articles by this author Pavel Gavrilov More articles by this author Oscar Rodriguez Faba More articles by this author Alex Mottrie More articles by this author Carme Facundo More articles by this author Lluís Guirado More articles by this author Joan Palou More articles by this author Alberto Breda More articles by this author Expand All Advertisement Loading ...

V02-01 NEW TECHNOLOGIES IN ROBOT-ASSISTED KIDNEY TRANSPLANTATION: IMPROVING SURGICAL PERFORMANCES, EXPANDING THE INDICATION

V02-01 NEW TECHNOLOGIES IN ROBOT-ASSISTED KIDNEY TRANSPLANTATION: IMPROVING SURGICAL PERFORMANCES, EXPANDING THE INDICATION

Step-by-step Development of a Cold Ischemia Device for Open and Robotic-assisted Renal Transplantation

BackgroundKidney transplantation (KT) is the best renal replacement treatment. The rewarming time is associated with ischemia/reperfusion damage. In both the open (open KT [OKT]) and the robotic (robotic-assisted KT [RAKT]) approaches, ice slush is used to maintain graft temperature (T°) below 20 °C. This may result in nonhomogeneous graft T° maintenance and, particularly during RAKT where the graft is completely inside the abdominal cavity, rises concerns regarding systemic hypothermia. ObjectiveTo design a cold ischemia device (CID) to maintain a constant and homogeneous low graft T° during surgery. Design, setting, and participantsIn IDEAL phase 0, a CID was developed and tested to determine its cooling effect on the kidney inside a closed system at 37.5 °C, by comparing it with kidney alone versus a gauze-jacket filled with ice slush. The CID was evaluated in pigs undergoing OKT and RAKT, assessing feasibility and adverse reactions. In IDEAL phase 1, the CID was tested in human OKT and RAKT. Surgical procedureOKT and RAKT. MeasurementsIn all phases, T° was evaluated at scheduled time points. Results and limitationsIn the preliminary tests of IDEAL phase 0, the CID was able to maintain a low graft T° and superiority to other groups (p = 0.002). In the in vivo animal model, the CID maintained a low and constant graft T° in OKT (n = 3) and RAKT (n = 3), with a mean T° at 50 min of 10.8 °C and 14.9 °C, respectively. IDEAL phase 1 demonstrated feasibility of both approaches (OKT, n = 2 and RAKT, n = 3) using the CID, and graft T° never exceeded 20 °C (mean T°: OKT 15.7 °C vs RAKT 18.3 °C). No complications were recorded. The main limitation consists in the low number of participants. ConclusionsThe CID assured a constant low graft T° during rewarming time, in both OKT and RAKT. Patient summaryA cold ischemia device (CID) is the first step toward a feasible, safe, and reproducible method to maintain a low graft temperature during surgery. The employment of a CID may optimize the functional outcomes.

Effectiveness of reaching and maintaining therapeutic hypothermia target temperature using low‐cost devices in newborns with hypoxic–ischemic encephalopathy

AbstractTherapeutic hypothermia (TH) using servo‐controlled cooling devices has proved to be a safe and effective method to reduce mortality and sequelae in neonates with hypoxic–ischemic encephalopathy (HIE). However, such cooling devices can be expensive and have limited availability in low‐ and middle‐income countries. To evaluate the feasibility and effectiveness of low‐cost cooling devices (ice packs) to reach and maintain the target temperature in newborns with moderate or severe HIE. Descriptive retrospective cross‐sectional study, including newborns with gestational age ≥35 weeks, weight ≥1800 g, with diagnosis of moderate or severe HIE, submitted to whole body hypothermia using ice packs for 72 hr. Data was obtained from medical records and databases. The thermal curves of each patient, time spent at the target temperature and rewarming time were evaluated. Complications directly related to therapeutic hypothermia, evolution, and early outcomes before hospital discharge were analyzed. Seventy‐one newborns met the criteria for TH, and 61 completed the entire cooling period and were included in the final analysis. The average time to reach the target temperature was 1.50 ± 1.3 hr. The mean temperature during the cooling period was 33.5°C (±0.62). 82.32% of the measurements were within the target temperature range (from 33 to 34°C). The following adverse events were observed during TH: pulmonary hypertension 11.3%, arrhythmia 4.2%, and coagulopathy 26.7%. Whole body hypothermia using low‐cost devices proved to be an effective method in the absence of availability of servo‐controlled devices, representing a plausible option in restricted resource settings.

Temperature management on cardiopulmonary bypass: Is it standardised across Great Britain and Ireland?

Temperature management is an essential element of cardiopulmonary bypass (CPB), as indicated in the Guide to Good Practice in Clinical Perfusion, 'The safe conduct of CPB requires the clinical perfusionist to measure and control. . . blood temperature. . . during the period of bypass'. To review current practice, we have conducted a research survey into the management of temperature on CPB. Surveys were distributed to each centre in Great Britain and the Republic of Ireland, investigating numerous temperature management practices, to elucidate current practice and assess if recent research into temperature management marry routine clinical practice. Our results demonstrate that nasopharyngeal temperature is the most common (52%) temperature site used across the many centres, which correlates with previous research as a routine site for cerebral temperature management. The arterial outlet of the oxygenator temperature was used in 33% of centres, however, all centres lacked the knowledge to maintain this temperature below 37°C. There was significant variation between all centres, especially regarding rewarming times (20-40 minutes), demonstrating a lack of uniformity among perfusion centres. Interestingly, most centres have been using the same protocol that has been in place over the previous 10 years.To conclude, the practice of temperature management is changing with the awareness of new research. Lower target temperatures are recommended for rewarming, ensuring a lower temperature gradient and a longer mean rewarming time.

Transplantation rénale robot-assistée avec donneur vivant : expérience d’un centre universitaire français

The main objective was to report the intra-, post-operative and functional outcomes of living-donor robotic-assisted kidney transplantation (RAKT), performed by a surgeon skilled in robotic surgery. The secondary objective was to compare the results of RAKT, based on the surgeon's experience. For this retrospective cohort study, we analyzed data from consecutive patients who underwent living-donor RAKT from July 2015 to March 2020 and compared the results of RAKT according to the surgeon's experience (group 1: 1-14th RAKT versus group 2: 15-29th RAKT). Twenty-nine living-donor RAKT were performed. The median age and BMI of the recipients were: 57.0 (44.0-66.0) years and 32.7 (23.5-39.6)kg/m2. The median overall operative time and median console time were: 140.0 (122.5-165.0) and 120.0 (107.5-137.5) minutes. The median rewarming time, arterial, venous and urinary anastomoses durations were: 35.0 (27.5-45.0), 15.0 (11.0-20.0), 12.0 (10.0-16.0), 20.0 (16.0-23.0) minutes. Two (6.9%) minor and 5 (17.2%) major (Clavien-Dindo≥III) postoperative complications occurred. At 2 years of follow-up, patient and transplant survival was 100% (n=29) and 93.1% (n=27). After the 14th RAKT, the rewarming time (P=0.01) and venous anastomosis duration (P=0.004) were statistically shorter. Living-donor robotic-assisted kidney transplantation, performed by a surgeon skilled robotic surgery, ensures good functional results in the medium term. 3.

Rapid vs. Slow Rewarming for Management of Moderate to Severe Hypothermia in Low-Birth-Weight Pre-term Neonates—An Open Label Randomized Controlled Trial

Evidence is lacking regarding the optimal method of rewarming hypothermic low-birth-weight (LBW) pre-term neonates. We aim to evaluate the effect of rapid vs. slow rewarming in the management of moderate to severe hypothermia in LBW pre-term neonates. In this open label, randomized controlled trial, 100 LBW (<2.5 kg), pre-term (<37 weeks) neonates with moderate to severe hypothermia (<36°C) was randomized to two groups of 50 each and received either rapid (at >0.5°C/h) or slow (at ≤0.5°C/h) rewarming rate till normothermia. The primary outcome was stabilization score [TOPS (temperature, oxygenation, perfusion and saturation) and MSNS (modified sick neonatal score)] at baseline, 6 and 24 h and mortality until discharge. Other neonatal morbidities were assessed as secondary outcomes. Mean TOPS score and MSNS score at baseline, 6 and 24 h of admission as well as change in score from baseline were similar between the two groups. The median rewarming rate [interquartile range (IQR)] was higher in rapid rewarming group than in the slow rewarming group [5.05°C/h (3.54-7.71) vs. 0.71°C/h (0.60-0.90); p < 0.001]. The median rewarming time taken in rapid rewarming group was lesser compared with that in the slow rewarming group [0.31 h (IQR 0.13-0.75) vs. 2.05 h (IQR 1.11-3.03); p < 0.001]. Mortality in rapid rewarming and slow rewarming group was similar [7/50 vs. 5/50; OR 1.46 (0.43-4.97), p = 0.538]. Rapid rewarming was as effective and safe as slow rewarming in the management of moderate to severe hypothermia in LBW pre-term neonates with similar short-term neonatal outcomes. CTRI/2018/01/011187.