Project of Support to Controlled Donation after Circulatory Death Through a Normothermal Regional Perfusion Mobile Equipment for Hospitals of the Community of Madrid. Spain. Start-Up and Preliminary Result.
Marina Pérez Redondo1,2, Inmaculada Fernández Simón 1, Inés Lipperheide Vallhonrat 1, Cándido Pardo Rey 3, Alfonso Ortega López 1, Héctor Villanueva Fernández 1, Sara Alcántara Carmona 1, Manuel González Romero3, Rubio Muñoz Juan José1,2, Francisco del Río Gallegos3.
1Critical care unit, Hospital Puerta de Hiero Majadahonda, Madrid, Spain; 2Transplant Coordinator, Hospital Puerta de Hiero Majadahonda, Madrid, Spain; 3Transplant Coordination, Hospital Clinico San Carlos, Madrid, Spain
Introduction: Normothermic regional perfusion with extracorporeal membrane oxygenation (NRP-ECMO) has been used in controlled donation after circulatory death(cDCD) in recent years with promising results. However, it is a highly complex procedure not available in most hospitals in the Community of Madrid (CM), Spain.
Objectives: To promote the use of the NRP-ECMO in the CM through the creation of a multidisciplinary team capable of moving to any hospital with a cDCD program.
Materials and Methods: The project began in July of 2016 after the economical support of a research grant from the Mutua Madrileña Foundation to the Clínico San Carlos and Puerta de Hierro Majadahonda hospitals.
It was divided into the following phases:
1.Drafting of the work protocol and presentation in the Regional Office of Transplant Coordination (ORCT) and in the ONT(National Transplant Organitation). They will manage the graft distribution among transplant hospitals.
2.Training courses for the team members.
3.Presentation of the project in the Ministry of Health of the CM, the two hospitals responsible for it and in the emergency servicies SUMMA 112.
5.Start of the project.
6.Preliminary evaluation.
Results:
From July 2016 to April 2017:
1.Four training courses based on clinical simulation were carried out. The NRP-ECMO team was integrated by an intensivist / transplant coordinator, a surgeon and a perfusionist
2.The project was presented in interhospital sessions and among transplant coordinators of the CM and a secure information web platform was created (www.asistoliamadrid.es)
3.The project was supported institutionally by the Ministry of Health of the CM.
4.The clinical phase began in April 2017, with results until November 2017 presented in Table 1
Conclusion:
1.The creation of a mobile NRP-ECMO team has been possible and now in the CM is a reality.
2.Its implementation has facilitated the use of this technique, by professionals with experience, in any hospital of the CM with cDCD program
3.It has facilitated the feasibility improvement of organs for transplant, especially the liver.
4.To make sure the real utility of the proyect, we must follow up, mainly the recipients, for a long time.
