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ASAIO CARDIAC ABSTRACT

ECMO SUPPORT IN DONATION AFTER CARDIAC DEATH, AN OPTION FOR ORGAN PERFUSION AND RECONDITIONING

Rojas, A1; Chen, L1; Bartlett, R H1; Arenas, J D1

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The major limitation in liver transplantation (LT) has been organ shortage. A solution, is the use of donors after cardiac death (DCD); however complications due to warm ischemia (WI), specifically biliary tract injury have been reported. We propose that using ECMO in DCD, we can support organ perfusion in the absence of cardiac activity, thereby bestowing organ protection during prolonged WI periods. Methods: Anesthetized swine were cardiac arrested (CA) and reperfused using v-a ECMO. Systemic and hepatic hemodynamics (Hep. art. Flow -HAF; Hep. Tissue Perfusion Flow -QFlow; and bile output) were recorded. Three groups (n = 8) were studied; two groups, Pre-H30 and Pre-HLO, heparinization (10KU i.v. heparin) before CA was achieved and ECMO support started 30 and 60 minutes after CA. In the third group, POSt-H30, heparin was given simultaneously with the initiation of ECMO after 30min CA. Data analysis was performed by One-way RMANOVA with Turkey test within groups, and Two-way RMANOVA between groups. Results: In all the groups, there was a significantly decrease in blood pH and SO2 at the end of CA. There were no significant differences between groups during ECMO in hemodynamics compared to baseline. However, when compared, there were significant differences in bile production (p<0.001) and AST level (p<0.05) between groups. Summary: Warm blood reperfusion using ECMO in DCD might be a surrogate to preischemic conditioning, and heparin before CA improves organ protection. Bile analysis (qualitative/quantitative) provides objective assessment of organ viability prior transplantation when DCD are used.

Copyright © 2004 by the American Society for Artificial Internal Organs