Performing Under Pressure: Maintenance of Donor Lung Pressure During Cabin Depressurization
Presented During: Welcome Reception and Poster Competition | Sponsored by: TransMedics
Baylor University Medical Center
Dallas, TX
United States - Contact Me
Education: Creighton University School of Medicine 2020
Residency: Baylor University Medical Center 2026
Research Fellowship: Post-Doctoral Research Fellow Baylor Scott and White The Heart Hospital Plano
Friday, September 20, 2024: 5:00 PM - 6:30 PM
Omni King Edward Hotel
Description
Objective: The International Society for Heart and Lung Transplantation (ISHLT) Consensus Statement on Donor Heart and Lung Procurement recommends static lung inflation to 12-15 cm H2O prior to explant to protect from barotrauma. This is particularly important during fixed wing air transport as there are inevitable atmospheric pressure drops even in pressurized cabins. We report a case of cabin depressurization with no affect on allograft pressure due to organ preservation using the BAROguard™ device (Paragonix Technologies, Inc., Waltham, MA), designed to maintain stable pressure and temperature during donor organ transportation.
Methods: Donor lungs were procured from a 55-year-old brain dead female with a history of coronary artery disease status post myocardial infarction, diabetes mellitus and hypertension, and a limited smoking history. Perfadex® (XVIVO, Molndal, Sweden) was used for perfusion without ex vivo lung perfusion, and lungs were placed into a BAROguard device with a goal pressure of 12-15 cmH2O, and goal temperature of 4-8oC. Upon reaching 18,000 feet, a sudden loss of cabin pressure occurred due to a door seal malfunction. The aircraft consequently made an emergency landing and an alternate charter flight was arranged and were safely delivered to the recipient center 1,069 miles away.
Results: The lungs were implanted off-pump into a 54-year-old Caucasian female with idiopathic pulmonary fibrosis, with a left lung total ischemic time of 8:42 hours and right lung total ischemic time of 10:15 hours. At 72 hours the patient was extubated with grade 1 primary graft dysfunction, and ultimately discharged home on room air on post-operative day 12.
A review of the pressure log within the transport system revealed that the lungs remained in the recommended intermediate pressure zone, never exceeding 16.1 cm H2O nor dropping below 12.8 cm H2O (Figure 1).
Conclusions: Active pressure control during allograft transport not only avoids over- or under-inflation of donor lungs, but can also compensate during a rare but possible in-flight depressurization emergency. Despite a long ischemic time and potential allograft atelectasis from depressurization, graft function remained excellent resulting in a successful patient outcome.
Authors
John Eisenga (1), Magdy El-Sayed Ahmed (2), Sigrid Ringenberg (3), Shair Ahmed (4), Gary Schwartz (1)
Institutions
(1) Baylor University Medical Center, Dallas, TX, (2) N/A, Jacksonville, FL, (3) Baylor University Medical Center, part of Baylor Scott & White Health, Dallas, TX, (4) Emory University School of Medicine, Atlanta, GA
Methods: Donor lungs were procured from a 55-year-old brain dead female with a history of coronary artery disease status post myocardial infarction, diabetes mellitus and hypertension, and a limited smoking history. Perfadex® (XVIVO, Molndal, Sweden) was used for perfusion without ex vivo lung perfusion, and lungs were placed into a BAROguard device with a goal pressure of 12-15 cmH2O, and goal temperature of 4-8oC. Upon reaching 18,000 feet, a sudden loss of cabin pressure occurred due to a door seal malfunction. The aircraft consequently made an emergency landing and an alternate charter flight was arranged and were safely delivered to the recipient center 1,069 miles away.
Results: The lungs were implanted off-pump into a 54-year-old Caucasian female with idiopathic pulmonary fibrosis, with a left lung total ischemic time of 8:42 hours and right lung total ischemic time of 10:15 hours. At 72 hours the patient was extubated with grade 1 primary graft dysfunction, and ultimately discharged home on room air on post-operative day 12.
A review of the pressure log within the transport system revealed that the lungs remained in the recommended intermediate pressure zone, never exceeding 16.1 cm H2O nor dropping below 12.8 cm H2O (Figure 1).
Conclusions: Active pressure control during allograft transport not only avoids over- or under-inflation of donor lungs, but can also compensate during a rare but possible in-flight depressurization emergency. Despite a long ischemic time and potential allograft atelectasis from depressurization, graft function remained excellent resulting in a successful patient outcome.
Authors
John Eisenga (1), Magdy El-Sayed Ahmed (2), Sigrid Ringenberg (3), Shair Ahmed (4), Gary Schwartz (1)
Institutions
(1) Baylor University Medical Center, Dallas, TX, (2) N/A, Jacksonville, FL, (3) Baylor University Medical Center, part of Baylor Scott & White Health, Dallas, TX, (4) Emory University School of Medicine, Atlanta, GA