Improvement of donor myocardial function after treatment of autonomic storm during brain death

Gérard Audibert, Claire Charpentier, Carole Seguin-Devaux, Pierre Alain Charretier, Hélène Grégoire, Yvan Devaux, Jean François Perrier, Dan Longrois, Paul Michel Mertes*

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

59 Citations (Scopus)

Abstract

BACKGROUND. In experimental brain death models, autonomic storm (AS) triggers severe myocardial dysfunction, which can be attenuated by pharmacologic treatment. The aim of this study was to determine the incidence of AS in a cohort of human organ donors and to evaluate the potential interest of AS treatment on myocardial function, cardiac harvesting and transplantation. METHODS. The cohort consisted of 152 patients. Among them, 46 patients were initially considered as potential cardiac donors (main criteria: age <60 years, no history of cardiac disease). AS diagnosis included increased systolic arterial pressure >200 mm Hg associated with tachycardia >140 beats/min. Heart acceptance criteria were associated creatine kinase (CK), troponin Ic, and left ventricle ejection fraction (LVEF) estimated by echocardiography and visual inspection. RESULTS. AS was observed in 29 patients (63%). Hypertension was treated in 12 patients (esmolol n=6, urapidil n=5, nicardipine). Cardiac harvesting was performed in 28 donors (61%). LVEFs were significantly higher after AS treatment (no AS: 55.4±13.4%, untreated AS: 49.0±18.8%, treated AS: 63.9+±10.3%, P=0.049). AS treatment was found to be independently associated with LVEF in >50% of the cases (P=0.034). Treatment of AS or the lack of AS were associated with an increased probability of successful cardiac transplantation (OR=8.8; 95% CI 2.1-38.3, P=0.002). CONCLUSIONS. Treatment of hypertension during AS may attenuate brain death-induced myocardial dysfunction and increase the number of available cardiac grafts.

Original languageEnglish
Pages (from-to)1031-1036
Number of pages6
JournalTransplantation
Volume82
Issue number8
DOIs
Publication statusPublished - Oct 2006
Externally publishedYes

Keywords

  • Autonomic storm
  • Brain death
  • Heart transplantation

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