organ donation in the ed
DESCRIPTION
ORGAN DONATION in the ED. Presented by:. Robert D. Kerns, NREMT-P, CPTC. Advanced Practice Coordinator. UWHC In-House Coordinator. UWHC Organ Procurement Organization. Lee Faucher, MD. Director of Trauma Services. UWHC. OBJECTIVES. - PowerPoint PPT PresentationTRANSCRIPT
ORGAN DONATION in the ED
Presented by:Robert D. Kerns, NREMT-P, CPTCAdvanced Practice CoordinatorUWHC In-House CoordinatorUWHC Organ Procurement Organization
Lee Faucher, MDDirector of Trauma ServicesUWHC
OBJECTIVES
Identify potential emergent and/or uncontrolled DCD candidates Define Uncontrolled DCD Define the process of successful Uncontrolled DCD Identify the resources needed to support an Uncontrolled DCD
candidate Identify the staff needed for a successful Uncontrolled DCD Demonstrate that the care received in the ER directly impacts
Donation even if the patient makes admission to the ICU Identify barriers to Uncontrolled DCD in the ER Identify strategies to overcome barriers to Uncontrolled DCD Identify key members of hospital staff that can champion
Uncontrolled DCD Define communication strategies for hospital staff that will
facilitate the Uncontrolled DCD process Define communication strategies that will support families
when presenting the option of Uncontrolled DCD
OBJECTIVES
Identify potential emergent and/or uncontrolled DCD candidates Define Uncontrolled DCD Define the process of successful Uncontrolled DCD Identify the resources needed to support an Uncontrolled DCD
candidate Identify the staff needed for a successful Uncontrolled DCD Demonstrate that the care received in the ER directly impacts
Donation even if the patient makes admission to the ICU Identify barriers to Uncontrolled DCD in the ER Identify strategies to overcome barriers to Uncontrolled DCD Identify key members of hospital staff that can champion
Uncontrolled DCD Define communication strategies for hospital staff that will
facilitate the Uncontrolled DCD process Define communication strategies that will support families
when presenting the option of Uncontrolled DCD
CASE 1
0209: Patient arrived at ED ~20 Year old male in high speed MVC Long extrication w/ deaths on scene ETT upon arrival Patient had severe closed head injury Left femoral head dislocation
0345: Patient to OR for Craniotomy Patient has bilat SDH Left > Right Hematoma evacuated spontaneously Bone flap left out and closed
CASE 1
0601: Admitted to TLC CVP placed Patient began bleeding profusely from
all open areas ICP remained elevated Patient maxed on Epi, Norepi, and Neo Requiring continuous FFP and PRBC’s
CASE 1
0802: Family Discussion Family decides to WLS Family agrees to Organ Donation OPO Activated
CASE 1
0830: OPO arrived on TLC Received report from Attending MD Met with patient’s parents
CASE 1
0845: Activated OPO recovery team to UW Scheduled OR for 0930 0900: Written consents completed Serology blood drawn Family services arrives at TLC
CASE 1
0930: OPO recovery team in TLC 0945: Patient to OR with TLC Attending 1030: Extubation 1051: CTOD 1057: Organ recovery begun
CASE 1
Kidneys recovered for transplant– 2 patients are transplanted
Eye and tissue recovered– 2 patients’ sight restored– 100’s of patients benefited from tissue
transplants
CASE 1 - Outcome
0802: OPO activated 0830: OPO arrives in TLC 0845: OPO recovery team activated & OR set 0900: Written consent completed 0930: OPO recovery team arrives 0945: Patient to OR 1030: Extubation
CASE 1 – Emergent DCD
Emergent DCD
Can this happen at your hospital?
YES!!
CASE 2
0942: Patient arrives at ED ~ 10 year old male w/ GSW to head Patient in full arrest & ETT upon arrival to ED Patient stabilized in ED and then to CT Head CT shows non survivable injury No NOK available yet Pt to be supported and admitted to PICU
1007: OPO activated from ED 1032: Patient arrives in PICU 1035: OPO arrives in PICU Patient is being supported NO NOK yet Police in PICU attempting to locate NOK ME notified and clears case for donation
CASE 2
1037: Activated OPO recovery team Reserved OR for emergency DCD Pt stabilized on pressors and albumin No NOK yet
CASE 2
1101: OPO recovery team onsite OR suite ready Serology blood drawn No NOK yet
CASE 2
1137: Patient’s mother on phone w/ PICU 1140: Mother decides to WLS & consents for DCD
Mother is over an hour away 1141: Patient is moved to OR w/ PICU staff
and Police 1142: CPR begun 1147: arrive in OR 1201: Extubation & CPR stopped 1206: CTOD 1208: Organ recovery begun
CASE 2
Kidneys recovered for transplant– 2 patients are transplanted
Eye and tissue recovered– 2 patients’ sight is restored– 100’s of patients benefited from tissue
transplants
CASE 2 - Outcome
1007: OPO activated from ED 1035: OPO arrives in PICU 1037: Recovery team activated & OR set 1101: Recovery team onsite 1140: Consent obtained for DCD 1141: Patient to OR and CPR begun 1201: Extubation
CASE 2 – Uncontrolled DCD
Uncontrolled DCD
Can this happen at your hospital?
YES!?!?
ORGAN DONATION in the ED
Lee Faucher, MD
Director of Trauma Services UWHC
Disclosure
Started my medical career as an EMT in East-Central Wisconsin
Worked as a Surgical Technician at the UW while in college– Member of the transplant team
Faculty member of the Division of General Surgery since 2004– Director of Trauma since 2006
CASE 3
22 year old male involved in a motor vehicle crash.– Unconscious– Intubated for airway control and diminished
mental status– Blood pressure and pulse present and stable– Obvious external injury to head, without
other signs of trauma
CASE 3
Social worker has contact information for mother about two hours away.
Mother said she wanted him to be a donor if nothing else could be done.
DISCUSSION
UNCONTROLLED DCD EMERGENT DCD
THANK YOU!!