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 lg/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.

Hemodynamic Resuscitation With Arginine Vasopressin Reduces Lung Injury After Brain Death in the Transplant Donor

“…Use of standardized donor maintenance protocols, which include hormonal resuscitation, have increased the number of organs procured (15). Animal studies have demonstrated a benefit in cardiac contractility and hemodynamics (16). However, in a recent prospective clinical study (17,18), hormonal resuscitation did not increase the number of suitable donors, but the substitution of norepinephrine with vasopressin did confer some benefit.…”

Physiologic response of human brain death and the use of vasopressin for successful organ transplantation

“…To correct the endocrinopathies of the donor, a combination hormone therapy with vasopressin, thyroid hormones, and methylprednisolone has been used to increase the likelihood of successful organ transplantation [18][19][20]. We were able to maintain adequate serum sodium level and urine output while using vasopressin, but they worsened once vasopressin was discontinued.…”

Combining Cariporide with Glyceryl Trinitrate Optimizes Cardiac Preservation During Porcine Heart Transplantation

“…We used pigs whose body weight was close to that of adult humans. All donor animals were subjected to brain death and managed for 6 h with a protocol incorporating 'combined hormone resuscitation', which has been shown to improve heart function and donor hemodynamics in both animal models and human subjects (16,(25)(26)(27)(28), and which has been recommended for human donor management (11,29 (6,31). In this study, we chose to combine cariporide with GTN for a number of reasons.…”