Abstract

An organ donor PaO2 above 40 kPa is generally required for lung transplantation. Point-of-care (POC) blood gas analyzers are commonly used by organ procurement organizations (OPO) but may underestimate the PaO2 at high levels. We hypothesized that changing to a more accurate blood gas analyzer would result in additional lungs transplanted. All PaO2 measurements on organ donors managed at one OPO’s recovery center were performed on an i-STAT POC analyzer prior to October 2015, and on a GEM 4000 subsequently. For 24 weeks, all blood gases were tested simultaneously on both analyzers. We compared lung outcomes of 147 donors in the year prior to this change (using the i-STAT) with 56 donors in the 24-week study period (using the GEM 4000 for lung allocation). When the PaO2 was above 40 kPa, the i-STAT PaO2 was 7.2 kPa lower on average than the GEM 4000. When the GEM PaO2 measured between 40 and 50 kPa, the corresponding i-STAT PaO2 value registered less than 40 kPa 25 out of 48 times (52%), with an average difference of 7.3 kPa (SD = 2.9). The rate of lungs transplanted using the GEM 4000 was 48% compared with 35% in the year prior using the i-STAT (p = .11), with equivalent recipient outcomes. The i-STAT analyzer underestimated the PaO2 above 40 kPa and changing to a more accurate PaO2 analyzer may increase lungs transplanted.

摘要

肺移植通常需要超过 40 kPa 的器官供体 PaO2。即时 (POC) 血气分析仪通常被器官采购组织 (OPO) 使用，但可能会低估高水平的 PaO2。我们假设改用更准确的血气分析仪会导致移植更多的肺。2015 年 10 月之前，在一个 OPO 康复中心管理的器官捐献者的所有 PaO2 测量均在 i-STAT POC 分析仪上进行，随后在 GEM 4000 上进行。24 周内，所有血气都在两台分析仪上同时测试。我们比较了这一变化前一年的 147 名捐赠者（使用 i-STAT）与 24 周研究期间的 56 名捐赠者（使用 GEM 4000 进行肺分配）的肺部结果。当 PaO2 高于 40 kPa 时，i-STAT PaO2 为 7。平均比 GEM 4000 低 2 kPa。当 GEM PaO2 在 40 和 50 kPa 之间测量时，相应的 i-STAT PaO2 值记录小于 40 kPa 48 次中有 25 次 (52%)，平均差异为 7.3 kPa (SD = 2.9)。使用 GEM 4000 的肺移植率为 48%，而使用 i-STAT 前一年为 35%（p  = .11)，接受者结果相同。i-STAT 分析仪低估了 40 kPa 以上的 PaO2，改用更准确的 PaO2 分析仪可能会增加移植的肺。