Lung recovery utilizing thoracoabdominal normothermic regional perfusion during donation after circulatory death: The Colorado experience.

Objective: Donation after circulatory death (DCD) procurement and transplantation after thoracoabdominal normothermic regional perfusion (TA-NRP) remains a novel technique to improve cardiac and hepatic allograft preservation but may be complicated by lung allograft pulmonary edema. We present a single-center series on early implementation of a lung-protective protocol with strategies to mitigate posttransplant pulmonary edema in DCD lung allografts after TA-NRP procurement.

Methods: Data from all lung transplantations performed using a TA-NRP procurement strategy from October 2022 to April 2023 are presented.

Goal-directed perfusion to reduce acute kidney injury: A randomized trial.

Objective: To determine whether a goal-directed perfusion (GDP) strategy aimed at maintaining oxygen delivery (DO) at ≥280 mL·min·m reduces the incidence of acute kidney injury (AKI).

Methods: This multicenter randomized trial enrolled a total of 350 patients undergoing cardiac surgery in 9 institutions. Patients were randomized to receive either GDP or conventional perfusion.

Neuroprotection Strategies in Aortic Surgery.

Neurologic injury is a potentially devastating complication of aortic surgery. The methods used in aortic surgery, including systemic cooling, initiation of circulatory arrest, and rewarming during the replacement of the aortic arch, are the most complex circulatory management and surgical procedures performed in modern-day surgery. Despite the plethora of published literature, neuroprotection in aortic surgery is largely based on observational studies and institutional-based practices.

A Clinical Protocol for Goal Directed Cerebral Perfusion during Aortic Arch Surgery.

Objective: The optimal strategy to deliver antegrade cerebral perfusion for cerebral protection during hypothermic circulatory arrest has not been established. The purpose of this review was to present our current clinical protocol utilizing selective antegrade cerebral perfusion during aortic arch surgery and to compare it to other published experience.

Clinical Protocol: Since 2013, our clinical protocol for aortic arch surgery has evolved to using selective antegrade cerebral perfusion via the innominate artery, moderate hypothermia, and ancillary strategies such as goal-directed perfusion (GDP).

Perfusion Electronic Record Documentation Using Epic Systems Software.

The authors comment on Steffens and Gunser's article describing the University of Wisconsin adoption of the Epic anesthesia record to include perfusion information from the cardiopulmonary bypass patient experience. We highlight the current-day lessons and the valuable quality and safety principles the Wisconsin-Epic model anesthesia-perfusion record provides.

Ex vivo lung perfusion allows successful transplantation of donor lungs from hanging victims.

Background: Donor lungs acquired from victims of asphyxiation by hanging are not routinely used for lung transplantation because of the associated lung injury. Ex vivo lung perfusion (EVLP) is a technique to evaluate marginal donor lungs before transplantation. We report here our experience with the use of EVLP in donor lungs procured from victims of asphyxia by hanging.

How would I establish a perioperative blood salvage program?

Nearly one-quarter of the nation's blood supply is transfused to surgical patients. In many institutions, blood management programs that include autotransfusion (perioperative blood salvage) have been developed to decrease the need for allogeneic transfusion in eligible surgical patients. This article reviews management concepts related to an autotransfusion service.

Cytokine expression profile in human lungs undergoing normothermic ex-vivo lung perfusion.

Background: A donor lung shortage prevents patients from receiving life-saving transplants. Ex-vivo lung perfusion (EVLP) is a viable means of expanding the donor pool by evaluating and potentially improving donor lung function. The metabolic and inflammatory effects of EVLP on human lung tissue are currently unknown.

Percutaneous assisted venous return isolated limb perfusion.

Isolated limb perfusion (ILP) is a short term therapy used in conjunction with or without hyperthermia to deliver chemotherapeutic agents to localized areas, thus avoiding the severity of side effects caused by systemic administration. The most common treatment approach is hyperthermic isolated limb perfusion (HILP) with increased oxygenation of the chemotherapeutic perfusate for treatment of melanoma, soft tissue sarcoma, or synovial sarcoma. HILP traditionally involves open surgical dissection and direct cannulation.

Designing an integrated extracorporeal therapy service quality system.

Reorganization in clinical operations of a national service provider organization, Fresenius Medical Care Extracorporeal Alliance (FMC-EA), provided the opportunity to overhaul and integrate quality systems. Under the new structure, the management of acute dialysis, apheresis, open-heart perfusion, and intraoperative autotransfusion services were combined into an integrated service portfolio supported by a multidisciplinary team of nurses, perfusionists, and technicians. This communication is intended to be a concise review of the literature that establishes the foundation for the new quality system as well as a discussion of the five clinical policies and clinical procedure guidelines that govern clinical behavior in mobile, point of care, acute extracorporeal therapy services.