title: The impact of early hormonal therapy in catastrophic brain-injured patients and its effect on organ procurement.
abstract: The purpose of this study was to evaluate the impact of early hormonal therapy on organ procurement from catastrophic brain-injured patients. All catastrophic brain-injured patients admitted to a high-volume academic Level I trauma center who underwent successful organ procurement over  a 3-year period (2006 to 2008) were reviewed. Patients were divided into two groups, those who received hormone therapy (HT) before brain death (BD) declaration and those who received HT after BD declaration. Thirty-two (60.4%) received HT before BD and 21 (39.6%) HT after BD. Trauma was the  most common cause of brain injury in both groups (before BD 96.9 vs after BD 90.5%, P = 0.324). There were no significant differences in demographics and clinical data. Patients receiving HT before BD were more hypotensive on admission (28.2 vs 9.5%, P = 0.048);  however, they required vasopressors less frequently (62.5 vs 100.0%, P = 0.001), for a shorter duration (17.2 ± 16.3 hours vs 33.1 ± 34.9 hours, P = 0.043), and at a lower dosage. Time from admission to procurement did not differ between the two groups  (109.8 ± 83.1 hours vs 125.0 ± 79.9 hours, P = 0.505). Patients receiving HT before BD had significantly more organs procured (4.5 ± 1.5 vs 3.5 ± 1.3, P = 0.023). Although catastrophic brain-injured patients receiving early hormonal therapy  were more hypotensive, they required less vasopressors and had higher procurement rates. The early use of hormonal therapy may decrease the need for vasopressors and increase the salvage of potentially transplantable organs.
authors.affiliation: Division of Acute Care Surgery and Surgical Critical Care, Los Angeles, University of Southern California, Los Angeles, California 90033-4525, USA. lydialam2@gmail.com
authors.forename: Lydia
authors.initials: L
authors.lastname: Lam
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Bernardino Castelo
authors.initials: BC
authors.lastname: Branco
authors.forename: Bradley
authors.initials: B
authors.lastname: Putty
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Green
authors.forename: Peep
authors.initials: P
authors.lastname: Talving
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000328:Adult; D001926:Brain Death; D001930:Brain Injuries / Q000188:drug therapy* / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006728:Hormones / Q000627:therapeutic use*; D006801:Humans; D007022:Hypotension / Q000188:drug therapy / Q000453:epidemiology; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055502:Secondary Prevention; D020858:Tissue and Organ Harvesting / Q000706:statistics & numerical data; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D006728:Hormones; D014662:Vasoconstrictor Agents