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How LUCAS® device affects kidney transplant rate in a “donors after circulatory death” program
Poster Presentations / Resuscitation 84S (2013) S8–S98
AP160 How LUCAS® device affects kidney transplant rate in a “donors after circulatory death” program Pilar Palma 1 , Angel Ruiz 2 , Francesc Carmona 1,∗ , Ramón Soliba 2 , Elisabet Barrau 3 , David Paredes 2
were timed later. Quantitative variables were described as median and interquartile range and were compared using Wilcoxon T test. Results: 12 out of 24 (50%) ALS teams of the city of Barcelona participated in the study. The median times (plus interquartile range) for the LUCAS and manual scenarios, and Wilcoxon T test p values are exposed in the table:
1
Sistema d’Emergències Mèdiques, Catalonia, Spain Donation Unit, Hospital Clínic, Barcelona, Spain 3 ABS Montclar, ICS, Sant Boi de Llobregat, Spain 2
Purpose: To analyze how LUCAS® device has affected kidney transplant rate in a “donor after circulatory death” program (DACDP) and to describe donors’ characteristics after 10 years of the program start. Methods: A prospective analytic study was performed from January 2002 to December 2011. From all the potential donors in a DACDP, all those who finally accomplished the program criteria were entered in NECMO and were not rejected by other causes different than those related to perfusion. Studied variables were: donors’ sex, age, body mass index (BMI) and presence of cardio-circulatory risk factors (CCRF), total out-of-hospital CPR time (OHCPR), kidney transplantation and use of LUCAS® device. Qualitative data are presented as percents and compared with Chi square test. Quantitative data are presented as mean and standard deviation and compared with Student’s T test. A logistical regression model was performed to adjust the LUCAS® effect over transplantation by possible confounding factors. Results: From the 160 potential donors, 97 accomplished the study criteria. 91.8% (89) were males. The mean age was 47.8 years (SD = 12.3), mean BMI was 27.1 kg/m2 (SD = 4), and mean OHCPR was 60.3 min (SD = 17.8). 48.5% (47) had CCRF and LUCAS was used in 52.6% of patients (51). 144 out of 194 kidneys were transplanted. LUCAS® was associated with an increase of the transplant rate in a 13% (CI 95% = 0.7–25) (p = 0.039). Lower mean age and BMI were also associated with an increase of the transplant rate (p = 0.004 and 0.001). No other significant statistical association was observed but a trend in lower OHCPR mean (p = 0.145). After adjusting LUCAS effect by donors age and BMI, OHCPR and their first order interactions in a logistic regression model, the use of LUCAS® multiplies by 1.9 the transplantation odds (CI 95% = 0.94–3.8). Conclusions: The use of LUCAS® increases the number of transplanted kidneys when used in a DACDP. http://dx.doi.org/10.1016/j.resuscitation.2013.08.186 AP161 Does a mechanical chest compressor (LUCAS2® ) disturb the resuscitation interventions? Juan Carlos Rodríguez ∗ , Pilar Palma, Isabel ˜ Munoz, Francesc Xavier Jiménez, Gilberto Alonso, Fran Carmona Sistema d’Emergències Mèdiques, Catalonia, Spain Purpose: To analyze if the use of a mechanical chest compressor disturbs the main resuscitation interventions during advanced life support (ALS). Describe the time of the ALS interventions in an Emergency Medical System. Methods: The 24 advanced life support teams (doctor, nurse and emergency technician) of the Emergency Medical System of the city of Barcelona were asked to play 8 min of resuscitation simulations on mannequins, firstly with LUCAS chest compressor and afterwards without it, over a persistent ventricular fibrillation scenario. The simulations were video recorded and the objective times
S73
Start of simulation to...
Lucas simulation Time in seconds
Manual simulation Time in seconds
p value
1st chest compression 1st monitored rhythm 1st defibrillation 1st ventilation Venous access Tracheal intubation
13 (IQR = 11–15.5) 36 (IQR = 26–40.5) 91 (IQR = 62.5–145.5) 76 (IQR = 72–116) 155 (IQR = 86.5–243.5) 245 (IQR = 187–280)
17 (IQR = 13.5–26.5) 44 (IQR = 34.5–60.5) 117 (IQR = 96.5–164) 68 (IQR = 54–100.5) 90 (IQR = 85–243.5) 257 (IQR = 206–392)
0.05 0.05 0.117 0.013 0.308 0.091
All the tracheal intubation attempts were performed with ongoing chest compressions. Conclusions: The use of the LUCAS device not only does not disturb the main ALS interventions but even seems to improve both key times as first chest compression time and first defibrillation time. The intervention times are not bad as a whole with the exception of a prolonged first defibrillation time. http://dx.doi.org/10.1016/j.resuscitation.2013.08.187 Newborn Life Support AP162 Infrared thermography as a means to quantify the effects of intrauterine fetal hypoxia Aleksandr Urakov 2 , Natalia Urakova 1 , Vacheslav Dementyev 3,∗ 1
Izhevsk State Medical Academy, Izhevsk, Russia Institute of Mechanics, Ural Branch of RAS, Izhevsk, Russia 3 Perm National Research Polytechnic University, Perm, Russia 2
It is shown that the thermal images of newborn and adult can to quantify the effects of ischemia and hypoxia.1–4 The aim is to study the potential of IRT for early assessment of the condition of the newborn and the efficiency of its reanimation when undergoing intrauterine hypoxia. Methods: Conducted a surveillance of pregnancy and childbirth in 20 women with no signs of placental insufficiency (NEF) and intrauterine hypoxia fetus and 15 women with signs of NEF and low prenatal resistance to hypoxia fetus. Infrared thermometry of the fetal head was performed using a thermal imager brand NEC TH91XX.1,4 Results: The results showed that the local temperature in the skin parietal part of the head of live fetuses in the process of childbirth and immediately after them ranged between +31.6 ◦ C and +36.1 ◦ C. In the absence of symptoms NEF and there is a high stability of the fetus to hypoxia infrared portrait of the parietal part of the head is rarely significant differences in color. As some fetuses temperature above the central seam exceed the temperature of the skin over the bones of the skull on average by 2.8 ± 0.21 ◦ C (P < 0.05, n = 20). In the low resistance to hypoxia fetus and signs of NEF the portrait of their parietal part of the head rarely have significant differences in color in 10 fetuses. But 5 fetuses during the final stage of childbearing identified short-term periods with perverted dynamics of heat radiation of the scalp, forming a region of local hypothermia. Found that temperature portraits of heads of these fetuses were normalized only at offset these fetuses inside the birth canal.
AP160 How LUCAS® device affects kidney transplant rate in a “donors after circulatory death” program Pilar Palma 1 , Angel Ruiz 2 , Francesc Carmona 1,∗ , Ramón Soliba 2 , Elisabet Barrau 3 , David Paredes 2
were timed later. Quantitative variables were described as median and interquartile range and were compared using Wilcoxon T test. Results: 12 out of 24 (50%) ALS teams of the city of Barcelona participated in the study. The median times (plus interquartile range) for the LUCAS and manual scenarios, and Wilcoxon T test p values are exposed in the table:
1
Sistema d’Emergències Mèdiques, Catalonia, Spain Donation Unit, Hospital Clínic, Barcelona, Spain 3 ABS Montclar, ICS, Sant Boi de Llobregat, Spain 2
Purpose: To analyze how LUCAS® device has affected kidney transplant rate in a “donor after circulatory death” program (DACDP) and to describe donors’ characteristics after 10 years of the program start. Methods: A prospective analytic study was performed from January 2002 to December 2011. From all the potential donors in a DACDP, all those who finally accomplished the program criteria were entered in NECMO and were not rejected by other causes different than those related to perfusion. Studied variables were: donors’ sex, age, body mass index (BMI) and presence of cardio-circulatory risk factors (CCRF), total out-of-hospital CPR time (OHCPR), kidney transplantation and use of LUCAS® device. Qualitative data are presented as percents and compared with Chi square test. Quantitative data are presented as mean and standard deviation and compared with Student’s T test. A logistical regression model was performed to adjust the LUCAS® effect over transplantation by possible confounding factors. Results: From the 160 potential donors, 97 accomplished the study criteria. 91.8% (89) were males. The mean age was 47.8 years (SD = 12.3), mean BMI was 27.1 kg/m2 (SD = 4), and mean OHCPR was 60.3 min (SD = 17.8). 48.5% (47) had CCRF and LUCAS was used in 52.6% of patients (51). 144 out of 194 kidneys were transplanted. LUCAS® was associated with an increase of the transplant rate in a 13% (CI 95% = 0.7–25) (p = 0.039). Lower mean age and BMI were also associated with an increase of the transplant rate (p = 0.004 and 0.001). No other significant statistical association was observed but a trend in lower OHCPR mean (p = 0.145). After adjusting LUCAS effect by donors age and BMI, OHCPR and their first order interactions in a logistic regression model, the use of LUCAS® multiplies by 1.9 the transplantation odds (CI 95% = 0.94–3.8). Conclusions: The use of LUCAS® increases the number of transplanted kidneys when used in a DACDP. http://dx.doi.org/10.1016/j.resuscitation.2013.08.186 AP161 Does a mechanical chest compressor (LUCAS2® ) disturb the resuscitation interventions? Juan Carlos Rodríguez ∗ , Pilar Palma, Isabel ˜ Munoz, Francesc Xavier Jiménez, Gilberto Alonso, Fran Carmona Sistema d’Emergències Mèdiques, Catalonia, Spain Purpose: To analyze if the use of a mechanical chest compressor disturbs the main resuscitation interventions during advanced life support (ALS). Describe the time of the ALS interventions in an Emergency Medical System. Methods: The 24 advanced life support teams (doctor, nurse and emergency technician) of the Emergency Medical System of the city of Barcelona were asked to play 8 min of resuscitation simulations on mannequins, firstly with LUCAS chest compressor and afterwards without it, over a persistent ventricular fibrillation scenario. The simulations were video recorded and the objective times
S73
Start of simulation to...
Lucas simulation Time in seconds
Manual simulation Time in seconds
p value
1st chest compression 1st monitored rhythm 1st defibrillation 1st ventilation Venous access Tracheal intubation
13 (IQR = 11–15.5) 36 (IQR = 26–40.5) 91 (IQR = 62.5–145.5) 76 (IQR = 72–116) 155 (IQR = 86.5–243.5) 245 (IQR = 187–280)
17 (IQR = 13.5–26.5) 44 (IQR = 34.5–60.5) 117 (IQR = 96.5–164) 68 (IQR = 54–100.5) 90 (IQR = 85–243.5) 257 (IQR = 206–392)
0.05 0.05 0.117 0.013 0.308 0.091
All the tracheal intubation attempts were performed with ongoing chest compressions. Conclusions: The use of the LUCAS device not only does not disturb the main ALS interventions but even seems to improve both key times as first chest compression time and first defibrillation time. The intervention times are not bad as a whole with the exception of a prolonged first defibrillation time. http://dx.doi.org/10.1016/j.resuscitation.2013.08.187 Newborn Life Support AP162 Infrared thermography as a means to quantify the effects of intrauterine fetal hypoxia Aleksandr Urakov 2 , Natalia Urakova 1 , Vacheslav Dementyev 3,∗ 1
Izhevsk State Medical Academy, Izhevsk, Russia Institute of Mechanics, Ural Branch of RAS, Izhevsk, Russia 3 Perm National Research Polytechnic University, Perm, Russia 2
It is shown that the thermal images of newborn and adult can to quantify the effects of ischemia and hypoxia.1–4 The aim is to study the potential of IRT for early assessment of the condition of the newborn and the efficiency of its reanimation when undergoing intrauterine hypoxia. Methods: Conducted a surveillance of pregnancy and childbirth in 20 women with no signs of placental insufficiency (NEF) and intrauterine hypoxia fetus and 15 women with signs of NEF and low prenatal resistance to hypoxia fetus. Infrared thermometry of the fetal head was performed using a thermal imager brand NEC TH91XX.1,4 Results: The results showed that the local temperature in the skin parietal part of the head of live fetuses in the process of childbirth and immediately after them ranged between +31.6 ◦ C and +36.1 ◦ C. In the absence of symptoms NEF and there is a high stability of the fetus to hypoxia infrared portrait of the parietal part of the head is rarely significant differences in color. As some fetuses temperature above the central seam exceed the temperature of the skin over the bones of the skull on average by 2.8 ± 0.21 ◦ C (P < 0.05, n = 20). In the low resistance to hypoxia fetus and signs of NEF the portrait of their parietal part of the head rarely have significant differences in color in 10 fetuses. But 5 fetuses during the final stage of childbearing identified short-term periods with perverted dynamics of heat radiation of the scalp, forming a region of local hypothermia. Found that temperature portraits of heads of these fetuses were normalized only at offset these fetuses inside the birth canal.