Addition of direct peritoneal lavage to XXXX cadaver organ donor resuscitation improves organ procurement.

@entity1 @entity519 @entity4095 @entity298
BACKGROUND: Brain dead organ donors have altered central hemodynamic performance, impaired hormone physiology, exaggerated systemic inflammatory response, end-organ microcirculatory dysfunction, and tissue @entity519 . A new treatment, @entity298 ( @entity298 ), stabilizes vital organ blood flow after conventionally resuscitated shock to improve these derangements. STUDY DESIGN: A prospective case-control study of adjunctive @entity298 compared 26 experimental @entity1 (brain dead organ donors) to 52 controls (protocolized conventionally resuscitated donors). Actual organ procurement rates were compared with the Scientific Registry of Transplant Recipient predicted organ yield per @entity1 . Achievement of donor management goals and effective hepatic blood flow were recorded. RESULTS: Fourteen of 26 (53.8%) @entity1 treated with @entity298 achieved all donor management goals compared with 17 of 52 (32.7%) @entity1 treated with conventionally resuscitated (odds ratio  = 2.4; 95% CI, 0.92-6.3; p  = 0.06). @entity1 treated with @entity298 were more than 2 times as likely to achieve final @entity4095 >100 on 40% FiO2 compared with controls (odds ratio  = 2.8; 95% CI, 1-7.69; p  = 0.03). Also, @entity298 -treated @entity1 required less IV crystalloid during the first 12 hours of management ( @entity298 : 3,167    1,893 mL vs 4,154    2,100 mL; p  = 0.046) and required less vasopressor agents at 12 hours post resuscitation (odds ratio  = 7.7; 95% CI, 0.82-42; p  = 0.02). Direct peritoneal resuscitation @entity1 had enhanced effective hepatic blood flow and significantly higher organs transplanted per donor rates compared with controls (3.7    1.7 vs 3.1    1.3; p  = 0.024). CONCLUSIONS: Direct peritoneal resuscitation reduced IV fluid requirement and IV pressor use as well as increased hepatic blood flow and organs transplanted per donor. Direct peritoneal resuscitation studies show it to be a safe, effective method to augment organ donor resuscitation and additional large-scale trials should be conducted to validate these findings.
