CONGRESS ABSTRACT

Background: In Italy, death can be determined using either cardiac or neurological criteria. In selected patients in whom death cannot be declared by neurological criteria (Maastricht III; withdrawal of life‑sustaining therapy), when death occurs after cardiac arrest, the law mandates continuous electrocardiographic monitoring for at least 20 minutes, recorded on paper or digital support. In our institution, during donation after circulatory death (DCD) procedures, electrocardiographic monitoring is combined with transesophageal echocardiography (TEE) to assess cardiac mechanical activity. This approach allows death determination based on mechanical criteria (absence of aortic valve opening on TEE) even in the presence of QRS complexes on ECG (electromechanical dissociation). Objectives: To determine, in patients undergoing cDCD, the time interval between circulatory arrest documented by transesophageal echocardiography (absence of aortic valve opening) and the last QRS complex recorded on electrocardiography, in order to estimate the ischemic time saved compared with a procedure based solely on electrocardiographic asystole. Methods: We performed a retrospective review of cDCD procedures, analyzing the timing of circulatory arrest assessed by echocardiographic and electrocardiographic criteria. Specifically, we evaluated the proportion of patients in whom death occurred due to electromechanical dissociation versus primary asystole and quantified the time elapsed between the last ventricular complex on ECG and the completion of the legally required 20‑minute no‑touch period, as well as the mean ischemic time saved. Results: Among 51 patients included, 31 died due to electromechanical dissociation, while primary asystole was observed in 20 patients. The use of echocardiographic criteria to identify circulatory arrest resulted in a mean reduction of ischemic time of 3.5 minutes compared with the standard procedure based solely on electrocardiographic criteria (20 minutes of asystole). Conclusions: The introduction of transesophageal echocardiography for cardiac death determination during cDCD procedures represents a safe, ethical, and easily implementable innovation that reduces tissue and organ ischemic time. This approach has the potential to improve graft quality and, consequently, transplant outcomes.