The effects of hormone resuscitation on cardiac function and hemodynamics in a porcine brain-dead organ donor model.
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.
Hing
A J
AJ
Transplant Program, The Victor Chang Cardiac Research Institute, and Heart Transplant Unit, St Vincent's Hospital, Sydney, Australia. a.hing@victorchang.unsw.edu.au
Hicks
M
M
Garlick
S R
SR
Gao
L
L
Kesteven
S H
SH
Faddy
S C
SC
Wilson
M K
MK
Feneley
M P
MP
Macdonald
P S
PS
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
D006728:Hormones; D007328:Insulin; D014284:Triiodothyronine; D014667:Vasopressins; D009638:Norepinephrine; D008775:Methylprednisolone