title: The effects of hormone resuscitation on cardiac function and hemodynamics in a porcine brain-dead organ donor model.
abstract: We compared the effects of hormone resuscitation (HR) with a norepinephrine-based protocol on cardiac function, hemodynamics and need for vasopressor support after brain death in a porcine model. Following brain death induction, animals were treated with norepinephrine and fluids for 3 h. In the following 3 h, they continued on norepinephrine and fluids (control) or received additional HR (triiodothyronine, methylprednisolone, vasopressin, insulin). Data were collected pre-brain death, 3 and 6 h post-brain death. At 6 h, median norepinephrine use was higher in controls (0.563 vs. 0 microg/kg/min; p < 0.005), with 6/8 HR animals weaned off norepinephrine compared with 0/9 controls. Mean arterial pressure was higher in HR animals at 6 h (74 +/- 17 vs. 54 +/- 14 mmHg; p < 0.05). Cardiac contractility was also significantly higher in HR animals at 6 h (stroke work index 1.777 vs. 1.494). After collection of 6 h data, all animals were placed on the same low dose of norepinephrine. At 6.25 h, HR animals had higher stroke work (3540 +/- 1083 vs. 1536 +/- 702 mL.mmHg; p < 0.005), stroke volume (37.2 +/- 8.2 vs. 21.5 +/- 9.8 mL; p < 0.01) and cardiac output (5.8 +/- 1.4 vs. 3.2 +/- 1.2 L/min; p < 0.005). HR in a porcine model of brain death reduces norepinephrine requirements, and improves hemodynamics and cardiac function. These results support the use of HR in the management of the brain-dead donor.
authors.affiliation: Transplant Program, The Victor Chang Cardiac Research Institute, and Heart Transplant Unit, St Vincent's Hospital, Sydney, Australia. a.hing@victorchang.unsw.edu.au
authors.forename: A J
authors.initials: AJ
authors.lastname: Hing
authors.forename: M
authors.initials: M
authors.lastname: Hicks
authors.forename: S R
authors.initials: SR
authors.lastname: Garlick
authors.forename: L
authors.initials: L
authors.lastname: Gao
authors.forename: S H
authors.initials: SH
authors.lastname: Kesteven
authors.forename: S C
authors.initials: SC
authors.lastname: Faddy
authors.forename: M K
authors.initials: MK
authors.lastname: Wilson
authors.forename: M P
authors.initials: MP
authors.lastname: Feneley
authors.forename: P S
authors.initials: PS
authors.lastname: Macdonald
mesh_terms: D000818:Animals; D001926:Brain Death; D006321:Heart / Q000187:drug effects / Q000502:physiology*; D006728:Hormones / Q000494:pharmacology*; D007328:Insulin / Q000494:pharmacology; D008775:Methylprednisolone / Q000494:pharmacology; D023421:Models, Animal; D009638:Norepinephrine / Q000494:pharmacology; D012151:Resuscitation / Q000379:methods*; D013552:Swine; D014019:Tissue Donors; D014284:Triiodothyronine / Q000494:pharmacology; D014667:Vasopressins / Q000494:pharmacology
chemical_list: D006728:Hormones; D007328:Insulin; D014284:Triiodothyronine; D014667:Vasopressins; D009638:Norepinephrine; D008775:Methylprednisolone