The Application Of ECMO With CRRT For Maintaining The Organs Of Potential Organ Donors With Cardiopulmonary Failure After Brain Death

Objective:To investigate the functions of ECMO with CRRT for the potential organ donor after brain death with cardiopulmonary failure and to increase the coefficient of utilization of donor livers.Methods:We collected and analyzed the clinical data of 8 donors after brain death with cardiopulmonary failure and the data of their corresponding recipients from June 2015 to October 2019 in our transplantation center.Those 8 donors had received the treatment of ECMO and CRRT.Those data included the changes of blood pressure,dosage of vasoactive agents,liver function,renal function,urine volume and serum lactate level of those treated donors.We collected the liver function of those corresponding liver recipients.We contrasted their data with the 24 contemporary normal DBD and their livers recipients’.Result:With the treatment of ECMO and CRRT,the blood pressure of cardiopulmonary failure donors had increased from below 90/60mmHg with massive vasoactive agents under enough effective circulating volume to 100-140/60-90mmHg,and the using of vasoactive agents were decreased.The urine volume also increased.There were significant differences in Aspartate aminotransferase（AST）,total bilirubin（TB）,Na⁺and lactate（P=0.0002,P<0.0001,P=0.0029,P<0.0001）.There were finally 6 in 7 livers can be transplanted while 1 liver was discarded due to hyperbilirubinemia and 1 donor was dead due to cardiovascular collapse.14 kidneys were transplanted successfully.There was no significant differences of liver functions in the recipients.Conclusion:With the treatment of ECMO and CRRT,the hemodynamic instability and cardiovascular collapse can be ameliorated and the liver function of donors after brain death with cardiopulmonary failure can be improved and donated successfully.The indications of connecting CRRT to ECMO are:urine volume<0.5 ml·kg^-1·h^-1 during the use of ECMO;signs of systemic inflammatory response syndrome; disturbance of water,electrolyte and acid base;tissue edema.Finally,the treatment of ECMO and CRRT can promote the donation rate,coefficient utilization of organs and the quality of organs as well as ensure the recovery of organ recipients.