148 I . Condello : J Extra Corpor Technol 2024 , 56 , 147 – 148
1 . Optimized Organ Preservation : By ensuring that DO 2i is adequately matched to the metabolic demands of the organs , as reflected by O 2 ERi and VCO 2 , clinicians can reduce the risk of ischemic injury and improve the overall quality of the organs being preserved for transplantation .
2 . Early Detection of Metabolic Imbalances : Monitoring VCO 2 in conjunction with DO 2i provides an early warning system for metabolic imbalances , such as hyperlactatemia , which can indicate insufficient oxygen delivery . This allows for timely adjustments to perfusion settings , potentially preventing irreversible organ damage .
3 . Personalized Perfusion Strategies : The ability to monitor and adjust DO 2i in relation to O 2 ERi and VCO 2 enables the development of personalized perfusion strategies tailored to the specific needs of each donor . This approach can lead to more consistent and reliable outcomes in organ preservation and transplantation .
4 . Reduced Risk of Post-Transplant Complications : By maintaining an optimal balance between oxygen delivery and metabolic demand , the incidence of post-transplant complications , such as AKI and delayed graft function , can be reduced , leading to better long-term outcomes for transplant recipients .
Although current monitoring programs and devices from companies like Terumo , Eurosets , LivaNova , and Spectrum Medical are primarily designed for application during cardiopulmonary bypass in cardiac surgery , the scenario of NRP in DCD donors presents a promising new frontier . This emerging field could open significant opportunities for these companies to adapt and expand their technologies , potentially developing specialized solutions that target the unique challenges of NRP , ultimately enhancing organ preservation and transplantation outcomes . The potential benefits of monitoring DO 2i in relation to O 2 ERi and VCO 2 during NRP in DCD donors are substantial . Raising awareness about the importance of indexed DO 2 calculations , especially in a clinical context where traditional tools like Swan-Ganz catheters are used less frequently due to the widespread adoption of echocardiography , could stimulate a more holistic approach to indexed calculations in perfusion management [ 4 ]. This shift in focus may encourage clinicians to re-emphasize the value of these calculations , integrating them more fully into practice , and potentially driving innovation in monitoring programs and devices tailored to advanced scenarios like NRP in DCD donors . These parameters provide a comprehensive view of the metabolic and oxygenation status of the organs , enabling clinicians to optimize perfusion strategies and improve the quality and viability of the organs being preserved for transplantation . As research in this area continues to evolve , the incorporation of these advanced monitoring techniques into routine clinical practice could significantly enhance the success rates of organ transplantation from DCD donors , ultimately expanding the donor pool and saving more lives .
Ignazio Condello ( PhD ) Department of Cardiac Surgery , Anthea Hospital ,
Via Camillo Rosalba , n 35 , 7014 , Bari , Italy
References
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2 . Ranucci M , Di Dedda U , Cotza M , Zamalloa Moreano K . The multifactorial dynamic perfusion index : A predictive tool of cardiac surgery associated acute kidney injury . Perfusion . 2024 ; 39 ( 1 ): 201 – 209 .
3 . Condello I , Santarpino G , Nasso G , et al . Associations between oxygen delivery and cardiac index with hyperlactatemia during cardiopulmonary bypass . JTCVS Tech . 2020 ; 2:92 – 99 .
4 . Sanfilippo F , Noto A , Ajello V , et al . The use of pulmonary artery catheters and echocardiography in the cardiac surgery setting : a nationwide Italian Survey . J Cardiothorac Vasc Anesth . 2024 ; 38 ( 9 ): 1941 – 1950 .
Cite this article as : Condello I . The potential benefits of monitoring oxygen delivery in relation to O 2 ERi and VCO 2 during normothermic regional perfusion in DCD donors . J Extra Corpor Technol 2024 , 56 , 147 – 148 . https :// doi . org / 10.1051 / ject / 2024028 .