INTRODUCTION: There is a national shortage of organs available for transplantation and utilization rates for thoracic organs are less than 40%. The management of organ donors remains inconsistent, and the lack of proper physiologic support in patients donating after neurologic determination of death (DNDD) has been reported as the cause of up to 25% of procurement failures. The Flotrac is a minimally invasive hemodynamic monitor that connects to an arterial catheter to assess cardiac output and fluid responsiveness. Our objective was to measure the impact of using Flotrac to guide therapy on pulmonary function, vasopressor usage, fluid balance, and organs transplanted per donor (OTPD). We hypothesized there would be more OTPD in donors who had a Flotrac monitor guiding their management.
METHODS: Data were prospectively collected on a convenience sample of 40 standard-criteria DNDD donors. Stroke volume variation, cardiac index, and stroke volume index were incorporated into the donor management guidelines of a regional organ procurement organization. Demographics, PaO2:FiO2, number of vasopressors, net fluid balance from authorization to organ recovery, and OTPD were compared between DNDDs with Flotrac and those without.
RESULTS: The groups had similar age, cause of death, and baseline PaO2:FiO2. Over the course of donor management, the use of Flotrac was associated with a greater increase in PaO2:FiO2 (100.5 ± 112.9 vs 0.7 ± 116.9, p=0.01) and a trend toward a greater decrease in vasopressor usage (-0.5 ± 0.7 vs 0.0 ± 1.0 pressors/DNDD, p=0.11). The control group had a significant increase in net fluid balance (+2136 to +5245, p=0.01), while the flotrac group did not (+2036 to +2361, p=0.28). DNDDs with Flotrac had greater overall OTPD (4.2 ± 1.5 vs 2.7 ± 1.5, p=0.002), thoracic OTPD (1.2 ± 1.0 vs 0.4 ± 0.6, p=0.006), and percentage of livers transplanted (100% vs 61%, p=0.002). The remaining organs were transplanted equally in both groups.
CONCLUSION: The use of Flotrac was associated with improved hemodynamic and pulmonary endpoints as well as increases in both thoracic and overall OTPD. The implementation of this technology to aid providers may help ameliorate the shortage of organs available for transplantation and randomized controlled trials are warranted.
To cite this abstract in AMA style:Bergstrom B, Louis S, Peterson F, Aguiar H, Friedman M, Malinoski D. Use of the Flotrac System To Guide Donor Management Is Associated with Increased Organs Transplanted Per Donor, The [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/use-of-the-flotrac-system-to-guide-donor-management-is-associated-with-increased-organs-transplanted-per-donor-the/. Accessed October 31, 2020.
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