Suhrriis5469

New therapeutic agents such as checkpoint inhibitors are promising strategies in the treatment of metastatic melanoma. Transplant recipients are generally at higher risk of malign diseases. Limited data are available for the use and safety of these agents in this population. We describe a patient who had a stable transplant function over years after a combined heart and kidney transplantation. Immunosuppressive medications included tacrolimus and azathioprine and were later switched to sirolimus and azathioprine. Metastatic melanoma was diagnosed; after detailed explanation of the potential risk, the patient was initially treated with the anti-cytotoxic T-lymphocyte antigen-4 (CTLA-4) antibody ipilimumab but experienced an acute kidney graft rejection and rapid progression. Rejection therapy with high-dose corticosteroids was successful, and kidney function was stabilized. Because of the urgent request of the patient for additional therapy, he received a PD-1 inhibitor. Acute kidney graft rejection resulted, with indication for acute dialysis. He developed severe candida pneumonia and died despite extensive antimicrobial therapy. Checkpoint inhibitors have become the standard in a broad entity of tumors. Organ transplant patients are at higher risk of developing malignant diseases. Limited data are available for the use of checkpoint inhibitors in this subgroup, and the use of checkpoint inhibitors is associated with a high risk of graft rejection. Liver grafts from donors after cardiac death (DCD) involve a risk of failure owing to warm ischemia, among other factors. To minimize this important issue, new systems like normothermic regional perfusion have arisen. We report an observational and unicentric study focused on the results of liver transplantation after DCD, performing normothermic regional perfusion using extracorporeal membrane oxygenation. In the period between 2011 and 2018, 33 recipients underwent the procedure, 9 from Maastricht II DCD donor liver transplantation (LT) and 24 from Maastricht III DCD donors. The median recipient survival rose to 67 ± 9 months and 41 ± 7 months, respectively. Only 1 patient suffered from ischemic cholangiopathy needing retransplantation. Therefore, according to our experience, liver grafts from DCD using extracorporeal membrane oxygenation are suitable for LT. BACKGROUND The concept of brain death (BD) is not well understood in the general population; this lack of knowledge is one of the main factors that generates an attitude against organ donation. Older people are a population group that has rarely been studied in relation to organ donation and transplantation (ODT), and it is important to investigate the most important aspects of ODT, such as people's concept of BD. OBJECTIVES To analyze the level of understanding of the concept of BD in people > 65 years of age and the factors that influence their mode of thinking. METHODS A multicenter study was carried out with a representative sample of people > 65 years of age, stratified by sex and geographic location in the southeast of Spain (n = 420). Knowledge of BD as well as the influence of other variables were analyzed through a validated questionnaire about ODT. SPSS version 21.0 (IBM Corp, Armonk, NY, United States) software was used for statistical analysis. Descriptive analysis included Student t test and the χ2 test. RESULTS The questionnaire had a completion rate of 84% (n = 351). In 36% (n = 127) of cases, people ˃ 65 years of age understood the concept of BD. In general, knowledge of this concept has not been associated with other variables including social-family interaction about ODT (P > .05). CONCLUSIONS Older people do not understand the concept of BD. It is, therefore, necessary to carry out informative campaigns on ODT explaining this concept. This would improve organ donation awareness in this particular group of people. INTRODUCTION The attitude toward living liver donation (LLD) among the Spanish population is mostly positive; however, the reality is that liver transplants from live donations are currently minimal. Given this situation, studies that analyze these discrepancies should be carried out. OBJECTIVE Analyze the attitude toward LLD among family members of patients on the waiting list for liver transplantation. METHOD Population under study. First-degree relatives of the patients included in the waiting list for liver transplantation. INCLUSION CRITERIA 1. Have the patient's authorization for family members to participate; 2. Accept, the relative, to participate in this investigation; and 3. Be over 18 years old. Opinion survey. The attitude toward LLD is assessed through a questionnaire on psychosocial aspects. RESULTS Patients who accepted family members' participation in the study were 21 of 112, of which 9 placed restrictions on family access, and 12 authorized family members without restrictions. The participants were 1. children 52.2% (n = 24); 2. brothers 30.5% (n = 14); and 3. partners 17.3% (n = 14). Finally, the authorized relatives and participants in the study were 45. Of these, only 44% (n = 20) would accept to be donors. CONCLUSIONS The access to the LLD of the relatives starts from the restriction and initial rejection of the patients themselves on the waiting list. The promotion of LDD is to initially sensitize patients. INTRODUCTION The population of Ghana has an emerging migratory flow to Europe and especially to Spain. Therefore, there is an increase in waiting lists in kidney transplantation. OBJECTIVE To analyze the attitude toward related living kidney donation (LKD) among the population born in Ghana and residing in Spain. MATERIAL AND METHODS Population under study. Population born in Ghana and resident in Spain. INCLUSION CRITERIA Sample of population over 15 years stratified by age and sex, according to census data and immigrant assistance associations. INSTRUMENT Validated attitude questionnaire toward LKD "PCID-DVR-Ríos." Field work. Random selection of people to be surveyed according to stratification. RESULTS A total of 237 respondents have been included in the study. 72% are in favor of LKD, not just related. The remaining 28% do not accept the related living donation or have doubts about it. Respondents in favor of the related LKD have a more positive attitude toward ODT (P  less then .001). The attitude toward related LKD is linked to socio-personal factors, knowledge factors about the donation and organ transplantation process, social interaction factors, attitude factors toward the body, religious factors, and the risk assessment that comes with a living donation (P  less then .05). In the multivariate analysis persists the attitude toward the cadaveric OTD (odds ratio [OR] = 6.993), perform pro-social activities (OR = 14.084), fear of body mutilation (OR = 20.408) and renal risk (OR = 29.411). CONCLUSIONS The Ghanaian population immigrating to Spain has an unfavorable attitude toward related LKD compared with existing studies of Western European and Spanish populations, which is conditioned by multiple psychosocial factors. Hypothermic cardiac arrest is rare and poses a challenge to prehospital responders. Standard cardiac arrest protocols advise treating reversible causes of arrest; however, rewarming the cold casualty is not easily achieved in the field. This article aimed to review the literature on hypothermia in order to produce evidence-based recommendations on rewarming that could realistically be applied to hypothermic cardiac arrest patients. Extracorporeal membrane oxygenation (ECMO), a term used to describe oxygenation that occurs outside of the body, is an increasingly common means of supporting the most critically ill patients. Because of the invasiveness and high probability of serious complications during ECMO, ECMO is typically indicated only when there is a high likelihood of death with conventional treatment. With continued improvements in technology and increasing clinical experience, transport clinicians are increasingly likely to be called on to transport patients on ECMO. ECMO can be initiated in 2 distinct forms, venovenous or venoarterial, and can primarily support the respiratory system or the cardiac and respiratory systems concurrently. This review will cover the basic physiology and components of ECMO as well as the preparation for ECMO transport for adults. OBJECTIVE The R Adams Cowley Shock Trauma Center (STC) is Maryland's primary adult resource center for trauma care. The Shock Trauma "Go-Team" is a specialized component of Maryland's emergency medical system and is composed of a physician and certified registered nurse anesthetist. They are dispatched when advanced prehospital resuscitation is required. The purpose of this study is to describe the capabilities and historic epidemiology outcomes of the Go-Team. METHODS A retrospective case series review of recoverable Go-Team records was performed from 2011 to 2018. Go-Team call logs/records were identified from multiple sources. Medical records were reviewed for patient demographics, mechanisms of injury, and treatments in the field. Selleckchem Kinase Inhibitor Library There was a total of 61 activations, with 22 deployments to the scene of injury. RESULTS The majority of deployments were via helicopter (73%) and lasted 2 hours. The most common indications for deployment were motor vehicle entrapment (41%), trench collapse (14%), and building collapse (9%). Of the 22 patients treated by the Go-Team, 50% received at least 1 blood transfusion in the field, and 23% required an advanced airway. No field amputations were required. CONCLUSION The STC Go-Team is a unique multidisciplinary specialized component of a statewide emergency medical system. INTRODUCTION Pediatric air transport research is limited, especially scene transport. Study purpose was to review transport epidemiology, outcomes, and documentation to inform development of a pediatric flight quality improvement (QI) program and outreach. METHODS Study design was ongoing review and analysis of flight, ED, EMS and hospital records over 2 years from children ≤ 18 years transported by a regional flight program. Mission type included trauma, medical, scene and interfacility. Records were reviewed monthly by a pediatric medical director (PMD) with ongoing QI and educational initiatives. Peer review was added in year two. Demographic and outcome variables included weight, times, procedures, pain scales, Glasgow Coma Scale (GCS), medications, disposition, etc. Two QI focus areas were studied using QI Macros® weight and pain documentation. RESULTS Children accounted for 8% of total flights (165/2076). Transport was 58% scene; 42% interfacility. Median dispatch to arrival time was 21 minutes. Saturday accounted for 24% of flights. Mean scene GCS was 12; 39 (24%) patients were intubated. Scene weight in kilograms improved 18% and pain documentation improved from 49% to 79% during the study. CONCLUSION Addition of PMD, peer and outcome review processes provided opportunities for improving pediatric transport QI initiatives and targeted outreach education. OBJECTIVE The Royal Flying Doctor Service Western Operations (RFDSWO) provides critical care transfer and retrieval services across 2.5 million km2 to a population of 2.58 million people, providing both primary and secondary retrievals across Western Australia. Flying on average 26 million km/y, retrievals are undertaken with the use of rotary and fixed wing aircraft. Our current fleet includes 16 Pilatus PC-12NGs turboprops, 2 Pilatus PC-24 jets, and access to 1 helicopter (Bell 412). A Hawker XP800 Jet was retired in 2019 after 10 years of service. Our retrieval teams are formed of either a doctor and a nurse or a nurse only on fixed wing missions and a doctor and critical care paramedic for helicopter emergency medical services missions. We present our experiences and caseload statistics over the past 5 years. METHODS We performed an analysis of our retrieval database looking at the workload from January 1, 2012, to December 31, 2016. This included the number of patients, age, ethnicity, type of retrieval, priority, diagnosis, and distances covered.