Prolonged hemodynamic maintenance by the combined administration of vasopressin and epinephrine in brain death: a clinical study.
The present study attempted long term hemodynamic maintenance in 16 adult brain-dead patients, 14 with head injury and 2 with cerebrovascular accidents. In addition to respiratory and fluid management, 10 were treated with continuous infusion of epinephrine to maintain systolic blood pressure above 90 mm Hg. The remaining 6 patients each received a continuous infusion of synthetic arginine vasopressin (ADH) at a rate of 1 or 2 units/hour (285 +/- 45 microunits/kg/minute) simultaneously with epinephrine. The 10 patients treated with epinephrine alone all succumbed to cardiac arrest within 48 hours of brain death, with a mean survival time of 24.1 +/- 17.2 hours. In the patients who received simultaneous ADH infusion, a minimal dose of epinephrine of no more than 0.5 mg/hr in most instances sufficed to maintain blood pressure. Their mean survival time after brain death was remarkably prolonged to 23.1 +/- 19.1 days. In brain death, ADH plays a critical role in hemodynamic maintenance, and ADH administration permits long term hemodynamic stabilization of brain-death patients, offering increasing opportunities for organ transplantation.
Yoshioka
T
T
Sugimoto
H
H
Uenishi
M
M
Sakamoto
T
T
Sadamitsu
D
D
Sakano
T
T
Sugimoto
T
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D001127:Arginine Vasopressin / Q000627:therapeutic use*; D001794:Blood Pressure; D001926:Brain Death; D001930:Brain Injuries / Q000503:physiopathology; D002302:Cardiac Output; D002561:Cerebrovascular Disorders / Q000503:physiopathology; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000517:prevention & control; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D014655:Vascular Resistance
D001127:Arginine Vasopressin; D004837:Epinephrine