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: A J Hing, M Hicks, S R Garlick, L Gao, S H Kesteven, S C Faddy, M K Wilson, M P Feneley, P S Macdonald
• Journal: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons (Am J Transplant) Vol. 7 Issue 4 Pg. 809-17 (Apr 2007) ISSN: 1600-6135 [Print] United States
• PMID: 17331116 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Hormones
• Insulin
• Triiodothyronine
• Vasopressins
• Norepinephrine
• Methylprednisolone

Topics

• Animals
• Brain Death
• Heart (drug effects, physiology)
• Hormones (pharmacology)
• Insulin (pharmacology)
• Methylprednisolone (pharmacology)
• Models, Animal
• Norepinephrine (pharmacology)
• Resuscitation (methods)
• Swine
• Tissue Donors
• Triiodothyronine (pharmacology)
• Vasopressins (pharmacology)