Title
Goal-directed abdominal normothermic regional perfusion: role of combined brain and somatic regional oxygen saturation in DCD donors
First and Presenting author
Marta Velia Antonini MSc m.antonini@unibo.it
Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy
Co-authors
Alessandro Circelli MD Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy
Emiliano Gamberini MD Intensive Care Unit, Morgagni – Pierantoni Hospital, AUSL della Romagna, Forlì, Italy
Maria Maddalena Bitondo MD Intensive Care Unit, Infermi Hospital, AUSL della Romagna, Rimini, Italy
Erika Cordella MD Emilia-Romagna Transplant Reference Centre, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Luca Bissoni MD Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy
Luca Gobbi MD Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy
Carlo Bergamini MD Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy
Monica Valbonetti MD Intensive Care Unit, Santa Maria delle Croci Hospital, AUSL della Romagna, Ravenna, Italy
Matteo Ravaioli Prof Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy AND General Surgery and Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Gaetano La Manna Prof Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy AND Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Vanni Agnoletti Prof Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy
Introduction
Normothermic regional perfusion (NRP) is a strategy of extracorporeal support increasingly implemented in donors undergoing circulatory determination of death (DCDDs). Regional oxygen saturation (rSO2), assessed through near-infra-red spectroscopy (NIRS), may be implemented to assess ante/postmortem values in different sites, in order to improve NRP effectiveness, and to early detect complications, allowing for a prompt management.
Methods
We aimed to assess the feasibility of using multi-site rSO2 to guide NRP. We simultaneously monitored bilateral cerebral and somatic rSO2. Renal rSO2 was considered the preferential site for somatic rSO2. Pads were placed above the kidneys, if renal cortex depth, located using ultrasound, was below 3 cm. If one or both kidneys were considered too deep, according to ultrasonographic measurement, an alternative site was considered. If the liver or the spleen could be located superficially between the paravertebral space and the midaxillary line, their monitoring was implemented. Anterior abdominal location was not suitable, considering the need for laparotomy. If splanchnic rSO2 was not feasible in the selected donor, rSO2 pads were placed on the limb (thigh or calf).
Results
We implemented a rSO2 guided reperfusion in DCDDs undergoing A-NRP from December 2024 to June 2025. Detailed data on the donors, on the site of rSO2 measurement, and on mean/median rSO2 values in pivotal timepoints (basal, hypotension and desaturation, asystole, end of no-touch-time, NRP, cold preservation solution administration) are included in figure 1.
Conclusions
Multisite rSO2 monitoring could be considered a non invasive, and cost-effective strategy to support NRP procedures in DCDDs. NIRS could be applied to assess effectiveness of extracorporeal blood flow in restoring a near-normal somatic rSO2 in the reperfused territory, or to detect an impaired oxygen delivery, to be furtherly explored. Moreover, the persistent lack of cerebral perfusion could be evaluated, to assess the effectiveness of regionalization.
For somatic assessment to be reliable, site of measurement should be carefully selected, considering donors characteristics, expected surgical procedure, and reperfusion configuration.
