Lauren Waxenberg
Research Mentor(s): Alvaro Rojas-Peña
Mentor Department: Department of Surgery-Transplantation
Authors: Lauren Waxenberg, Wyeth D Alexander, Vikramjit Chakrabortty, Martin Daman, Robert H Bartlett, Alvaro Rojas-Peña, Daniel Drake
Session: Session 1 (9:00am – 9:50am)
Presentation Type: Poster 48
Abstract
Utilization of allografts procured from donation after circulatory death (DCD) offers the potential to expand the transplantation donor pool amidst growing advancements in heart transplantation. Despite this, many DCD organs are discarded due to theoretical concerns of prolonged warm ischemic times inherent to procurement protocols. To further investigate the effect of prolonged warm ischemic times (>30min), a large animal model of DCD organ procurement was developed. Four adult-size pigs (49±7.07 kg) were instrumented under general anesthesia. Initial ventilatory settings were tidal volume (TV) 6-8cc/kg, respiratory rate (RR) 14, resulting minutes ventilation (MV) 100 cc/kg/min, PEEP 5 mmHg, FiO2 60%. The right femoral artery was catheterized under direct visualization for arterial monitoring and the right internal jugular vein was cannulated with a Cordis through which a swan-ganz was placed. Anesthesia was transitioned to fentanyl and midazolam infusions. A bolus of esmolol and esmolol infusion was administered for blunting of the cardiovascular response to hypoxia and hypocarbia. Removal of life support with simulated agonal breathing was achieved by adjusting the vent settings to room air FiO2 with one of three MV conditions: Short agonal time (SAT): MV 10-15% baseline MV Intermediate agonal time (IAT): MV 20-25% MV Prolonged agonal time (PAT): MV 45-50% MV Data collection entailed: Q5min hemodynamic monitoring, Q5min ABG/VBGs, and cardiac output using an Edwards. Initiation of the agonal period was defined as a sustained SBP < 50mmHg or SaO2 <70%. The current study was designed to produce a novel large animal model for DCD organ procurement. The proposed agonal breathing titrations are expected to produce agonal times that would clinically correlate to organs that would be utilized (agonal times <30min), organs that would be marginally utilized (agonal times ~30min), and organs that would be rejected (agonal times >30min).
