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From JAMA |

Better Than the Lungs We Are Taking Out

Ashish S. Shah, MD
Arch Surg. 2011;146(6):645-646. doi:10.1001/archsurg.2011.123.
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ABSTRACT

JAMA

Effect of a Lung Protective Strategy for Organ Donors on Eligibility and Availability of Lungs for Transplantation: A Randomized Controlled Trial

Luciana Mascia, MD, PhD; Daniela Pasero, MD; Arthur S. Slutsky, MD; M. Jose Arguis, MD; Maurizio Berardino, MD; Salvatore Grasso, MD; Marina Munari, MD; Silvia Boifava, MD; Giuseppe Cornara, MD; Francesco Della Corte, MD; Nicoletta Vivaldi, MD; Paolo Malacarne, MD; Paolo Del Gaudio, MD; Sergio Livigni, MD; Elisabeth Zavala, MD; Claudia Filippini, PhD; Erica L. Martin, PhD; Pier Paolo Donadio, MD; Ilaria Mastromauro, MD; V. Marco Ranieri, MD

Context:   Many potential donor lungs deteriorate between the time of brain death and evaluation for transplantation suitability, possibly because of the ventilatory strategy used after brain death.

Objective:   To test whether a lung protective strategy increases the number of lungs available for transplantation.

Design, Setting, and Patients:   Multicenter randomized controlled trial of patients with beating hearts who were potential organ donors conducted at 12 European intensive care units from September 2004 to May 2009 in the Protective Ventilatory Strategy in Potential Lung Donors Study.

Interventions:   Potential donors were randomized to the conventional ventilatory strategy (with tidal volumes of 10-12 mL/kg of predicted body weight, positive end-expiratory pressure [PEEP] of 3-5 cm H2O, apnea tests performed by disconnecting the ventilator, and open circuit for airway suction) or the protective ventilatory strategy (with tidal volumes of 6-8 mL/kg of predicted body weight, PEEP of 8-10 cm H2O, apnea tests performed by using continuous positive airway pressure, and closed circuit for airway suction).

Main Outcome Measures:   The number of organ donors meeting eligibility criteria for harvesting, number of lungs harvested, and 6-month survival of lung transplant recipients.

Results:   The trial was stopped after enrolling 118 patients (59 in the conventional ventilatory strategy and 59 in the protective ventilatory strategy) because of termination of funding. The number of patients who met lung donor eligibility criteria after the 6-hour observation period was 32 (54%) in the conventional strategy vs 56 (95%) in the protective strategy (difference of 41% [95% confidence interval {CI}, 26.5% to 54.8%]; P> < .001). The number of patients in whom lungs were harvested was 16 (27%) in the conventional strategy vs 32 (54%) in the protective strategy (difference of 27% [95% CI, 10.0% to 44.5%]; P = .004). Six-month survival rates did not differ between recipients who received lungs from donors ventilated with the conventional strategy compared with the protective strategy (11/16 [69%] vs 24/32 [75%], respectively; difference of 6% [95% CI, −22% to 32%]).

Conclusion:   Use of a lung protective strategy in potential organ donors with brain death increased the number of eligible and harvested lungs compared with a conventional strategy.

Trial Registration:   clinicaltrials.gov Identifier: NCT00260676

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