Dataset Information

Wait, treat and see: echocardiographic monitoring of brain-dead potential donors with stunned heart.

ABSTRACT:

Background

Heart transplantation is limited by a severe donor organ shortage. Potential donors with brain death (BD) and left ventricular dysfunction due to neurogenic stunning are currently excluded from donation--although such abnormalities can be reversible with aggressive treatment including Hormonal Treatment (HT) and deferred organ retrieval.

Aim

To assess the recovery of left ventricular dysfunction in potential brain-dead donors with hemodynamic instability treated by aggressive treatment and HT.

Methods

In a single-center, observational study design, we evaluated 15 consecutive brain-dead potential donors (DBD) (8 males, age?=?48?±?15?years) with hemodynamic instability. All underwent standard hemodynamic monitoring and transthoracic 2-dimensional echo (2-DE) with assessment of Ejection Fraction (EF). Measurements were obtained before BD and after BD within 6?h, at 24?h and within 48?h. HT (with insulin, methylprednisolone, vasopressin and T3) was started as soon as possible to treat hemodynamic instability and avoid administration of norepinephrine (NE). Eligible potential heart donors underwent coronary angiography.

Results

After HT, we observed a normalization of hemodynamic conditions with improvement of mean arterial pressure (pre?=?68?±?8?mmHg vs post?=?83?±?13?mmHg, p?ConclusionIn BD donors, intensive treatment including HT is associated with improvement of regional and global LV function and reverse remodeling detectable by transthoracic 2DE. Donor hearts with recovered LV function may be eligible for uneventful heart transplant. The wait (in brain death), treat (with HT) and see (with 2D echo) strategy can help rescue organs suitable for heart donation.

SUBMITTER: Casartelli M

PROVIDER: S-EPMC3439356 | biostudies-literature | 2012 Jun

REPOSITORIES: biostudies-literature

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Publications

Wait, treat and see: echocardiographic monitoring of brain-dead potential donors with stunned heart.

Casartelli Marilena M Bombardini Tonino T Simion Davide D Gaspari Maria Grazia MG Procaccio Francesco F

Cardiovascular ultrasound 20120621

<h4>Background</h4>Heart transplantation is limited by a severe donor organ shortage. Potential donors with brain death (BD) and left ventricular dysfunction due to neurogenic stunning are currently excluded from donation--although such abnormalities can be reversible with aggressive treatment including Hormonal Treatment (HT) and deferred organ retrieval.<h4>Aim</h4>To assess the recovery of left ventricular dysfunction in potential brain-dead donors with hemodynamic instability treated by aggr ...[more]

PMID: 22721412

Similar Datasets

Project description:BACKGROUND:Critical shortages of organs for transplantation jeopardize many lives. Observational data suggest that better fluid management for deceased organ donors could increase organ recovery. We conducted the first large multicenter randomized trial in brain-dead donors to determine whether protocolized fluid therapy increases the number of organs transplanted. METHODS:We randomly assigned donors to either protocolized or usual care in eight organ procurement organizations. A "protocol-guided fluid therapy" algorithm targeting the cardiac index, mean arterial pressure and pulse pressure variation was used. Our primary outcome was the number of organs transplanted per donor, and our primary analysis was intention to treat. Secondary analyses included: (1) modified intention to treat where only subjects able to receive the intervention were included and (2) 12-month survival in transplant recipients. The study was stopped early. RESULTS:We enrolled 556 donors: 279 protocolized care and 277 usual care. Groups had similar characteristics at baseline. The study protocol could be implemented in 76 % of subjects randomized to the intervention. There was no significant difference in mean number of organs transplanted per donor: 3.39 organs per donor (95 % CI 3.14-3.63) with protocolized care compared to 3.29 usual care (95 % CI 3.04-3.54; mean difference, 0.1, 95 % CI -0.25 to 0.45; p = 0.56). In modified intention-to-treat analysis the mean number of organs increased (3.52 organs per donor, 95 % CI 3.23-3.8), but not statistically significantly (mean difference, 0.23, 95 % CI -0.15 to 0.61; p = 0.23). Among the 1,430 recipients of organs from study subjects with data available, 56 deaths (7.8 %) occurred in the protocolized care arm and 56 (7.9 %) in the usual care arm in the first year (hazard ratio: 0.97, p = 0.86). CONCLUSIONS:In brain-dead organ donors, protocol-guided fluid therapy compared to usual care may not increase the number of organs transplanted per donor.

Dataset Information

Wait, treat and see: echocardiographic monitoring of brain-dead potential donors with stunned heart.

Background

Aim

Methods

Results

Publications

Wait, treat and see: echocardiographic monitoring of brain-dead potential donors with stunned heart.

Similar Datasets

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