Effects of Ketone Body 3-Hydroxybutyrate on Cardiac and Mitochondrial Function During Donation After Circulatory Death Heart Transplantation
A study led by Jacob Marthinsen Seefeldt et al. explored the impact of the ketone body 3-hydroxybutyrate (3-OHB) on cardiac and mitochondrial function in the context of heart transplantation following circulatory death. The research utilized normothermic regional perfusion (NRP) to assess the effects of therapeutic interventions in donor pigs, which were later transplanted into recipient…
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Ethical Choices in Organ Transplantation: Why Normothermic Machine Perfusion is Preferable to NRP
The article titled “Neither Ethical nor Prudent: Why Not to Choose Normothermic Regional Perfusion” by Adam Omelianchuk, published in The Hastings Center Report, critically examines the ethical dilemmas posed by the use of Normothermic Regional Perfusion (NRP) in organ transplantation, specifically in the context of Donation after Circulatory Determination of Death (DCD). NRP is a technique used to…
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Optimizing PEEP Management in Severe ARDS: The Role of Prone Positioning and ECMO
In the review article titled “Positive End-Expiratory Pressure Management in Patients with Severe ARDS: Implications of Prone Positioning and Extracorporeal Membrane Oxygenation,” authored by Christoph Boesing and colleagues and published in Critical Care, the ongoing challenge in managing severe acute respiratory distress syndrome (ARDS) revolves around determining the optimal strategy for titrating positive end-expiratory pressure…
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Efficient and Safe Aorta Cannulation in Organ Donation After Cardiac Death
Mohamed Abdullah et al. present an efficient and safe technique for cannulating a depressurized aorta during organ donation after cardiac death, utilizing thoracoabdominal normothermic regional perfusion (NRP). The procedure, performed with informed written consent from donors’ families and without needing institutional review board approval, begins after an independent physician declares death and a mandatory standoff…
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Simultaneous Pancreas and Kidney Transplantation from Donors after Circulatory Death in Switzerland
A recent study by Fabian Rössler and colleagues reports the first simultaneous pancreas and kidney transplantation (SPK) from donors after circulatory death (DCD) in Switzerland. This procedure is a critical advancement for type I people with diabetes and end-stage kidney disease, as it offers a curative treatment and expands the organ donor pool. SPK is…
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Normothermic Regional Perfusion in Donor Heart Recovery: Establishing a New Normal
The article discusses the evolving landscape of heart transplantation, mainly focusing on using Normothermic Regional Perfusion (NRP) in donor heart recovery. With the scarcity of heart donors being a persistent issue, the medical community has been exploring innovative ways to expand the donor pool, including using hearts from donors who are not brain-dead, a process…
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Comparing Post-Transplant Survival in Heart Transplants: Normothermic Regional Perfusion vs. Direct Procurement and Perfusion
A new study led by Gege Ran BA and colleagues examines the outcomes of heart transplants from donors after circulatory death (DCD), focusing on the two main heart procurement techniques: Normothermic Regional Perfusion (NRP) and Direct Procurement and Perfusion (DPP). Since 2019, the use of DCD hearts in transplantation has surged in the United States,…
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Evaluation of Cannula Sizes and Flow Rates in Venoarterial Extracorporeal Membrane Oxygenation: Insights from a Simulation Study
The study by Avishka Wickramarachchi and colleagues investigates the performance of different arterial and drainage cannulae sizes in venoarterial extracorporeal membrane oxygenation (VA ECMO) using a simulated patient model. Large cannulae, though effective, are associated with increased complications, while the efficacy of smaller cannulae still needs to be understood. The research tested arterial cannulae sizes…
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Optimizing Left Ventricular Unloading with ECPELLA: A Case Study and Decision-Making Guide
Left ventricular (LV) unloading using the Impella device in conjunction with veno-arterial extracorporeal membrane oxygenation (VA ECMO), known as ECPELLA, has demonstrated improved survival for patients experiencing cardiogenic shock, particularly those resuscitated post-cardiac arrest. Clear criteria and additional diagnostic and therapeutic tools for optimal LV unloading remain undefined despite its benefits. This article by John…
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Outcomes Associated with Absent Blood Product Utilization in Jehovah’s Witness Patients Compared to the Standard of Care in Cardiac Surgery: A Ten-Year Experience
A ten-year retrospective study by Nathan Fields et al. examined the outcomes of Jehovah’s Witness (JW) patients undergoing cardiac surgery without blood transfusions in comparison to non-JW patients who either received or did not receive blood products. Given JW patients’ refusal of blood transfusions, alternative strategies such as erythropoietin-stimulating agents, intravenous iron, and non-pharmacologic interventions…
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The Multifactorial Dynamic Perfusion Index: A Predictive Tool of Cardiac Surgery-Associated Acute Kidney Injury
Marco Ranucci and a team of dedicated colleagues have introduced a multifactorial dynamic perfusion index (MDPI) to enhance the prediction of cardiac surgery-associated acute kidney injury (CSA-AKI). This collaborative study, involving a retrospective analysis of 910 consecutive adult cardiac surgery patients, aimed to develop a dynamic predictive model that incorporates various preoperative and intraoperative risk…
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Risk Factors for Elective and Emergency Oxygenator Exchanges During Veno-Venous Extracorporeal Membrane Oxygenation
Oxygenator dysfunction remains a prevalent technical complication during Extracorporeal Membrane Oxygenation (ECMO) despite systemic anticoagulation and antithrombotic surface coating measures. The timing of oxygenator exchange, particularly emergency exchanges, presents a significant risk due to potential complications. This study by Olivier van Minnen et al. aimed to identify the risk factors and predictors for both elective…
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