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Use of the Lucas mechanical chest compression device in an asystolic organ donation program: effect on kidney perfusion and organ procurement and transplantation rate

Carmona Jim√©nez F, Ruiz Arr√°nz √Ā, Palma Padr√≥ P, Soto Garc√≠a √Ä, Alberola Mart√≠n M, Saavedra Escobar S

Sistema d'Emergències Mèdiques SEM-061, Barcelona, Spain, Unidad de Donación, Hospital Clínic, Barcelona, Spain.

Objective: To analyze whether using the Lucas mechanical chest compression device
while transporting potential non¬Ėheart-beating donors to the hospital has an effect on
kidney perfusion and the number of kidneys procured and transplanted.
Methods: Retrospective and prospective study of cases between January 2006 and
January 2010. Data reflected 2 phases: before introduction of the Lucas device in
February 2008 and afterwards. We analyzed the effect on our asystolic organ donor
program by comparing the results in non¬Ėheart-beating donor candidates (type 2
according to the Maastricht classification) transported under manual cardiopulmonary
resuscitation (CPR) or mechanical compressions. Variables recorded were age, sex, body
mass index, CPR or mechanical compression times, reasons for not procuring donated
organs, and organs procured and transplanted or rejected because of poor perfusion.
Data were extracted from the records of the transplant coordination unit of Hospital
Clínic de Barcelona.
Results: Of 203 cardiac-death donor candidates, 112 were transported with manual CPR
and 91 with compressions delivered by the Lucas device. The mean (SD) age of
candidates was 46.6 (13.1) years and 84.2% were men. The age and sex distribution in
the 2 time periods did not differ significantly (P=.86). In the manual CPR period 33% of
the candidates (n=37) became donors, whereas 37.4% (n=34) became donors in the
mechanical compression period (P=.52). Surgeons extracted 97.3% (n=72) of the
kidneys in the first period and 100% (n=68) in the second period (P=.34). Use of the
Lucas device was associated with an increase of 0.3 transplanted kidneys per donor
(95% CI, ¬Ė0.1 to 0.7) (P=.166) and a decrease of 32.9% in kidneys rejected because of
poor perfusion (95% CI, 3.8% to 56.6%) (P=.026).
Conclusions: Using the Lucas chest compression device helps maintain the rate of
transplanted kidneys and even tends to increase the rate slightly. After beginning to use
mechanical compression, we observed a significant decrease in the percentage of
kidneys rejected for poor perfusion.

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