227: ECMO Experience Increases Cannulation Strategies for Abdominal Normothermic Regional Perfusion

Introduction: Normothermic regional perfusion (NRP) is increasingly utilized to expand the organ donor pool from donors after circulatory death (DCD). ECMO professionals – physicians, perfusionists, nurses, and respiratory therapists – can contribute significant knowledge and experience to enhance the capabilities of NRP. Methods: In September 2021, an NRP program was developed at a high-volume ECMO and transplant center. Initial strategy mirrored established ECMO protocols, with pre-mortem placement of femoral arterial/venous sheaths that were wire-exchanged for post-expiration cannulas, with an intra-aortic occlusion balloon. When pre-mortem intervention was not possible, rapid central cannulation, as in thoraco-abdominal NRP, was utilized, requiring cardiothoracic surgery expertise, which became a limiting factor as the abdominal program grew. As our team’s efficiency, protocolization, and pump configuration developed, so did a protocol for abdominal transplant surgeons to directly cannulate intra-abdominal vessels. A retrospective review was performed with primary endpoints of organ utilization and outcome as well as cannulation strategy. Results: From 9/2021 to 7/2023, A-NRP was utilized in 24 DCDs (femoral= 10, central= 5, intra-abdominal= 9). Fourteen livers have been successfully transplanted (livers declined for: functional assessment= 5, biopsy=3, visual=2). NRP was performed in the OR, PACU, and ICU. To date, all recipients are alive with no known ischemic cholangiopathy. Discussion: Previous ECMO experience increases cannulation strategy variations that allow for maximal utilization of donor organs using NRP in different donor circumstances. Advantages and disadvantages of various cannulation strategies are summarized in the table. As experience increases, cannulation times and organ acceptance rates improve.