Scientific Letter
Interhospital transfers of a mobile team for organ preservation with extracorporeal membrane oxygenation in controlled donors after circulatory death
Desplazamientos interhospitalarios de un equipo móvil para preservación de órganos con oxigenación por membrana extracorpórea en donantes en asistolia controlada
J.M. Pérez-Villares
, R. Lara-Rosales
Corresponding author
Coordinación de Trasplantes y Servicio de Cuidados Críticos, Complejo Hospitalario Universitario de Granada, Granada, Spain
Read
5634
Timeswas read the article
2607
Total PDF
3027
Total HTML
Share statistics
array:24 [ "pii" => "S2173572718300109" "issn" => "21735727" "doi" => "10.1016/j.medine.2018.01.006" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "1055" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "copyrightAnyo" => "2017" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Intensiva. 2018;42:131-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1397 "formatos" => array:3 [ "EPUB" => 138 "HTML" => 703 "PDF" => 556 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0210569117301043" "issn" => "02105691" "doi" => "10.1016/j.medin.2017.02.010" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "1055" "copyright" => "Elsevier España, S.L.U. y SEMNIM" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Intensiva. 2018;42:131-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2331 "formatos" => array:3 [ "EPUB" => 179 "HTML" => 1430 "PDF" => 722 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científica</span>" "titulo" => "Desplazamientos interhospitalarios de un equipo móvil para preservación de órganos con oxigenación por membrana extracorpórea en donantes en asistolia controlada" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "131" "paginaFinal" => "133" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Interhospital transfers of a mobile team for organ preservation with extracorporeal membrane oxygenation in controlled donors after circulatory death" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.M. Pérez-Villares, R. Lara-Rosales" "autores" => array:2 [ 0 => array:2 [ "nombre" => "J.M." "apellidos" => "Pérez-Villares" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Lara-Rosales" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173572718300109" "doi" => "10.1016/j.medine.2018.01.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572718300109?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569117301043?idApp=WMIE" "url" => "/02105691/0000004200000002/v1_201802250513/S0210569117301043/v1_201802250513/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173572718300080" "issn" => "21735727" "doi" => "10.1016/j.medine.2018.01.004" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "1047" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Intensiva. 2018;42:134-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1144 "formatos" => array:3 [ "EPUB" => 166 "HTML" => 558 "PDF" => 420 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Comparative statistical analysis in observational epidemiological studies" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "134" "paginaFinal" => "135" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Análisis estadísticos comparativos en los estudios epidemiológicos observacionales" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Bosch-Gaya, L. Matute-Blanco, D. Fernández-Rodríguez, F. Worner" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Bosch-Gaya" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Matute-Blanco" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Fernández-Rodríguez" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "Worner" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210569117300694" "doi" => "10.1016/j.medin.2017.02.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569117300694?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572718300080?idApp=WMIE" "url" => "/21735727/0000004200000002/v1_201803150431/S2173572718300080/v1_201803150431/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173572718300092" "issn" => "21735727" "doi" => "10.1016/j.medine.2018.01.005" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "1053" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Intensiva. 2018;42:129-31" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1651 "formatos" => array:3 [ "EPUB" => 179 "HTML" => 934 "PDF" => 538 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Which multi-trauma patients benefit from performing a total-body CT?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "129" "paginaFinal" => "131" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Qué pacientes politraumatizados graves se benefician de la realización de un <span class="elsevierStyleItalic">total-body CT</span>?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 787 "Ancho" => 2833 "Tamanyo" => 232361 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Chest X-ray at hospital admission showing no significant alterations. (B) The arrow shows the descending thoracic aortic incomplete lesion with pseudoaneurysm, prior to the endovascular procedure. (C) Correct endovascular prosthesis implantation.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Dios-Barbeito, V. Durán-Muñoz-Cruzado, C. Martín-García, M. Rubio-Manzanares-Dorado, F.J. Padillo-Ruiz, F. Pareja-Ciuró" "autores" => array:6 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Dios-Barbeito" ] 1 => array:2 [ "nombre" => "V." "apellidos" => "Durán-Muñoz-Cruzado" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Martín-García" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Rubio-Manzanares-Dorado" ] 4 => array:2 [ "nombre" => "F.J." "apellidos" => "Padillo-Ruiz" ] 5 => array:2 [ "nombre" => "F." "apellidos" => "Pareja-Ciuró" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S021056911730102X" "doi" => "10.1016/j.medin.2017.03.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021056911730102X?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572718300092?idApp=WMIE" "url" => "/21735727/0000004200000002/v1_201803150431/S2173572718300092/v1_201803150431/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Interhospital transfers of a mobile team for organ preservation with extracorporeal membrane oxygenation in controlled donors after circulatory death" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear Editor</span>," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "131" "paginaFinal" => "133" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J.M. Pérez-Villares, R. Lara-Rosales" "autores" => array:2 [ 0 => array:4 [ "nombre" => "J.M." "apellidos" => "Pérez-Villares" "email" => array:1 [ 0 => "josem.perez.villares.sspa@juntadeandalucia.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Lara-Rosales" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Coordinación de Trasplantes y Servicio de Cuidados Críticos, Complejo Hospitalario Universitario de Granada, Granada, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Desplazamientos interhospitalarios de un equipo móvil para preservación de órganos con oxigenación por membrana extracorpórea en donantes en asistolia controlada" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Since the publication of the “2012 National Consensus Document on Donation in Asystole”,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> and ever since the “Royal Decree 1723/2012”<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> became effective back in January, 2013 the programs of controlled asystole donations (CAD) in Spain have grown exponentially.</p><p id="par0010" class="elsevierStylePara elsevierViewall">CAD have become the most obvious way to expand the number of transplants with a total of 370 donors in 2016, which is a 75 per cent increase compared to the previous year. This type of donation amounts to 18 per cent of the total of deceased donors, that is, one out of every five donors is a donor in controlled asystole. At present, a total of 68 Spanish hospitals have active programs on this type of donation.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">As it occurs with encephalic death donations (EDD), the role that intensivists play in the management of CAD is essential. Most CAD occur in patients in situations of catastrophic neurological damage with need for mechanical ventilatory support who remain hospitalized in our units, and whose families have accepted their decision of life support treatment limitation (LSTL). In some cases, the withdrawal of all measures is conducted after treatment has been rejected following the explicit wishes of the patient or his/her representatives.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The normothermal abdominal perfusion (NAP) with extracorporeal membrane oxygenation (ECMO) has been the most widely used preservation method for the last few years (22 per cent in 2015) for various reasons: there is a wide experience using it in uncontrolled asystole donations (UCAD); the surgical technique is similar to the one used with EDD; it is less conditioned by the donor's anatomy; there is a possibility of conducting intraoperative assessments of the donor's organs with expanded criteria; and there is the possibility of conducing intraoperative biopsies for organ assessment. The 2015 results suggest a lower delayed graft function and a higher survival rate of the hepatic graft whenever ECMO systems are used as a preservation method.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The Spanish experience with the use of NAP with ECMO for the management of UCAD has encouraged other countries like Great Britain<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> and the United States<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> to use it as a preservation method for CAD. In the experience of the University of Michigan,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> the results achieved in renal, hepatic, and pancreatic transplants are the same as in EDD, and far more superior than the super-rapid recovery technique used in CAD–shorter delays in the early graft function.</p><p id="par0030" class="elsevierStylePara elsevierViewall">One of the aspects that make it difficult to spread the use of NAP with ECMO is that it is a complex procedure that is not available in every hospital, especially those of rural areas, where there can be patients who have made LSTL decisions who can still be donors in CAD.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The Complejo Hospitalario Universitario de Granada has been running the UCAD program since 2010,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> and the CAD program since 2013. From 2010 there have been 85 asystole donations, and 71 abdominal preservations with ECMO systems in normothermia have been conducted. Among them, 23 have been in CAD, and in 20 of them, the NAP with ECMO system was used, which allowed 37 renal transplants, and 9 hepatic transplants. The ECMO system is run by transplant coordinators–all of us intensivists from the Intensive Care Unit here at the Complejo Hospitalario Universitario de Granada.</p><p id="par0040" class="elsevierStylePara elsevierViewall">We share the experience of having had four ECMOs trips outside our hospital since 2015: 2 to the Hospital Clínico San Cecilio–within the same city (1<span class="elsevierStyleHsp" style=""></span>km away), and 2 to a different province–Jaén, Spain. The trip to this province was to the Complejo Hospitalario de Jaén (92<span class="elsevierStyleHsp" style=""></span>km away), and to the Hospital San Agustín de Linares (136<span class="elsevierStyleHsp" style=""></span>km away). The mobile team deployed included one doctor from the transplant coordination team (intensivist); one nurse from the transplant coordination team; one vascular surgeon (for ECMO cannulation); and one urologist from the team of renal extraction. A second urologist was provided by the center where the extraction is conducted. This is the mobile team that will be deployed together with the material needed for the cannulation and the machine required for the ECMO system. The first two cases were conducted using the ECMO Maquet Rotaflow<span class="elsevierStyleSup">®</span> system, and ever since 2016 we have been using the ECMO Maquet Cardiohelp<span class="elsevierStyleSup">®</span> system (better monitoring and mobility). No general surgeon traveled with the team because the four cases reported were just renal donors (due to contraindication for hepatic donation).</p><p id="par0045" class="elsevierStylePara elsevierViewall">The donors were hospitalized in the intensive care units (ICU) of the aforementioned hospitals. Three males, and one woman with an average age of 56.5 years old (53–60). The reason for LSTL was anoxic encephalopathy in all four cases. The average time elapsed from ICU admission until LSTL was 9.75 days (4–19). Eight renal transplants; 4 corneal transplants; 2 extractions of osteotendinous tissue; and 1 extraction of vascular tissue were conducted (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Both the renal grafts and the receivers have had good progression. After digging into the available medical literature, we have not found any series published so far about donors in asystole being preserved using this method of deployed ECMO mobile teams for NAP in CAD.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The role played by intensivists in the field of organ donation is essential ever since the very first programs of donation and transplant were implemented in Spain, until the latest strategies in detection and maintenance of donors.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> In just a few years, CAD have become the most important way to increase the number of organ donations in our country. Recent high-interest recommendations from SEMICYUC task forces on bioethics and transplants on how to avoid therapeutic obstination; make LSTL decisions; and assess the possibility of CAD in patients who have made LSTL decisions see us as the most relevant professionals in the management of this type of donation.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Our capacitation in the management of life support systems allows us to guarantee the adequate preservation of the donor's organs in CAD through the use of ECMO systems. In our opinion, deploying mobile teams of intensivist transplant coordinators with ECMO systems makes CAD possible in hospitals where this resource is not available,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> which, in turn, increases the chances of donation in our ICUs.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pérez-Villares JM, Lara-Rosales R. Desplazamientos interhospitalarios de un equipo móvil para preservación de órganos con oxigenación por membrana extracorpórea en donantes en asistolia controlada. Med Intensiva. 2018;42:131–133.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">LSTL: life support treatment limitation; ICU-LSTL: intensive care unit-life support treatment limitation.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reason for LSTL \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time of ICU-LSTL admission \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Organs and tissues transplanted \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patient #1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Woman \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Anoxic encephalopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Two kidneys<br>Osteotendinous tissue<br>Vascular tissue \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patient #2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Anoxic encephalopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Two kidneys and corneas<br>Osteotendinous tissue \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patient #3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Anoxic encephalopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Two kidneys \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patient #4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Anoxic encephalopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Two kidneys and corneas \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1697981.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Characteristics of donors.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Donación en Asistolia en España: Situación actual y Recomendaciones. Documento de Consenso 2012. Página web Organización Nacional de Trasplantes. [Accessed January 2017]. Available in: <a id="intr0010" class="elsevierStyleInterRef" href="http://www.ont.es/infesp/DocumentosDeConsenso/DONACI%26Oacute;N%20EN%20ASISTOLIA%20EN%20ESPA%26Ntilde;%20A.%20SITUACI%26Oacute;N%20ACTUAL%20Y%20RECOMENDACIONES.pdf">http://www.ont.es/infesp/DocumentosDeConsenso/DONACIÓN%20EN%20ASISTOLIA%20EN%20ESPAÑ A.%20SITUACIÓN%20ACTUAL%20Y%20RECOMENDACIONES.pdf</a>" ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Real Decreto 1723/2012, de 28 de diciembre, por el que se regulan las actividades de obtención, utilización clínica y coordinación territorial de los órganos humanos destinados al trasplante y se establecen requisitos de calidad y seguridad. Página web Organización Nacional de Trasplantes. [Accessed January 2017]. Available in: <a id="intr0015" class="elsevierStyleInterRef" href="http://www.ont.es/infesp/Legislacin/BOERD1723-2012.pdf">http://www.ont.es/infesp/Legislacin/BOERD1723-2012.pdf</a>" ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Balance de actividad de la Organización Nacional de Trasplantes en 2016. [Accessed January 2017]. Available in: <a id="intr0020" class="elsevierStyleInterRef" href="http://www.ont.es/Documents/Presentaci%26oacute;nDatos2016-17.pdf">http://www.ont.es/Documents/PresentaciónDatos2016-17.pdf</a>" ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Informe de actividad de donación y trasplante de donantes en asistolia España 2015. [Accessed January 2017]. Available in: <a id="intr0025" class="elsevierStyleInterRef" href="http://www.ont.es/infesp/Memorias/INFORME%20DONACI%26Oacute;N%20EN%20ASISTOLIA%202015.pdf">http://www.ont.es/infesp/Memorias/INFORME%20DONACIÓN%20EN%20ASISTOLIA%202015.pdf</a>" ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Normothermic regional perfusion for donation after circulatory death without prior heparinization" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.J. Butler" 1 => "L.V. Randle" 2 => "C.J. Watson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/TP.0000000000000082" "Revista" => array:6 [ "tituloSerie" => "Transplantation" "fecha" => "2014" "volumen" => "97" "paginaInicial" => "1272" "paginaFinal" => "1278" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24646774" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Donation after circulatory determination of death: the University of Michigan experience with extracorporeal support" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Rojas-Peña" 1 => "L.E. Sall" 2 => "M.T. Gravel" 3 => "E.G. Cooley" 4 => "S.J. Pelletier" 5 => "R.H. Bartlett" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/TP.0000000000000070" "Revista" => array:6 [ "tituloSerie" => "Transplantation" "fecha" => "2014" "volumen" => "98" "paginaInicial" => "328" "paginaFinal" => "334" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24825520" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Código alfa. Inicio de un nuevo programa de donación en asistolia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Pérez-Villares" 1 => "R. Lara-Rosales" 2 => "F. Pino-Sánchez" 3 => "P. Fuentes-García" 4 => "E. Gil-Piñero" 5 => "A. Osuna-Ortega" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Intensiva" "fecha" => "2013" "volumen" => "37" "paginaInicial" => "223" "paginaFinal" => "230" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Medicina intensiva y donación de órganos. ¿Explorando las últimas fronteras?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Escudero" 1 => "J. Otero" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Intensiva" "fecha" => "2015" "volumen" => "39" "paginaInicial" => "366" "paginaFinal" => "374" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Recomendaciones de interés elevado de los Grupos de Trabajo de la SEMICYUC. [Accessed January 2017]. Available in: <a id="intr0030" class="elsevierStyleInterRef" href="http://www.semicyuc.org/sites/default/files/p_todos_gt.pdf">http://www.semicyuc.org/sites/default/files/p_todos_gt.pdf</a>" ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reflexiones sobre la donación en asistolia controlada (donantes tipo III de Maastricht)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.J. Rubio" 1 => "D. Palacios" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2016.04.003" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2016" "volumen" => "40" "paginaInicial" => "431" "paginaFinal" => "433" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27444801" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004200000002/v1_201803150431/S2173572718300109/v1_201803150431/en/main.assets" "Apartado" => array:4 [ "identificador" => "15647" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004200000002/v1_201803150431/S2173572718300109/v1_201803150431/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572718300109?idApp=WMIE" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 6 | 10 |
| 2024 October | 43 | 67 | 110 |
| 2024 September | 47 | 42 | 89 |
| 2024 August | 56 | 47 | 103 |
| 2024 July | 47 | 30 | 77 |
| 2024 June | 43 | 44 | 87 |
| 2024 May | 46 | 26 | 72 |
| 2024 April | 55 | 34 | 89 |
| 2024 March | 35 | 36 | 71 |
| 2024 February | 35 | 41 | 76 |
| 2024 January | 31 | 37 | 68 |
| 2023 December | 32 | 38 | 70 |
| 2023 November | 43 | 44 | 87 |
| 2023 October | 28 | 32 | 60 |
| 2023 September | 30 | 42 | 72 |
| 2023 August | 28 | 25 | 53 |
| 2023 July | 30 | 23 | 53 |
| 2023 June | 26 | 18 | 44 |
| 2023 May | 44 | 30 | 74 |
| 2023 April | 38 | 17 | 55 |
| 2023 March | 64 | 32 | 96 |
| 2023 February | 50 | 29 | 79 |
| 2023 January | 35 | 26 | 61 |
| 2022 December | 60 | 34 | 94 |
| 2022 November | 53 | 46 | 99 |
| 2022 October | 60 | 32 | 92 |
| 2022 September | 43 | 36 | 79 |
| 2022 August | 47 | 58 | 105 |
| 2022 July | 28 | 42 | 70 |
| 2022 June | 29 | 29 | 58 |
| 2022 May | 35 | 48 | 83 |
| 2022 April | 24 | 45 | 69 |
| 2022 March | 52 | 68 | 120 |
| 2022 February | 25 | 47 | 72 |
| 2022 January | 40 | 27 | 67 |
| 2021 December | 52 | 50 | 102 |
| 2021 November | 31 | 38 | 69 |
| 2021 October | 70 | 92 | 162 |
| 2021 September | 33 | 37 | 70 |
| 2021 August | 25 | 38 | 63 |
| 2021 July | 28 | 23 | 51 |
| 2021 June | 29 | 21 | 50 |
| 2021 May | 41 | 54 | 95 |
| 2021 April | 114 | 124 | 238 |
| 2021 March | 71 | 35 | 106 |
| 2021 February | 57 | 35 | 92 |
| 2021 January | 49 | 18 | 67 |
| 2020 December | 48 | 26 | 74 |
| 2020 November | 40 | 21 | 61 |
| 2020 October | 40 | 32 | 72 |
| 2020 September | 46 | 26 | 72 |
| 2020 August | 42 | 13 | 55 |
| 2020 July | 30 | 22 | 52 |
| 2020 June | 33 | 16 | 49 |
| 2020 May | 14 | 11 | 25 |
| 2020 April | 17 | 22 | 39 |
| 2020 March | 14 | 12 | 26 |
| 2020 February | 57 | 29 | 86 |
| 2020 January | 38 | 32 | 70 |
| 2019 December | 29 | 23 | 52 |
| 2019 November | 13 | 28 | 41 |
| 2019 October | 27 | 21 | 48 |
| 2019 September | 15 | 27 | 42 |
| 2019 August | 23 | 17 | 40 |
| 2019 July | 31 | 25 | 56 |
| 2019 June | 14 | 18 | 32 |
| 2019 May | 42 | 31 | 73 |
| 2019 April | 10 | 19 | 29 |
| 2019 March | 16 | 30 | 46 |
| 2019 February | 23 | 30 | 53 |
| 2019 January | 38 | 37 | 75 |
| 2018 December | 48 | 41 | 89 |
| 2018 November | 85 | 82 | 167 |
| 2018 October | 42 | 25 | 67 |
| 2018 September | 46 | 12 | 58 |
| 2018 August | 50 | 7 | 57 |
| 2018 July | 36 | 13 | 49 |
| 2018 June | 34 | 15 | 49 |
| 2018 March | 0 | 1 | 1 |
Show all
