TY - JOUR
T1 - Improvement of donor myocardial function after treatment of autonomic storm during brain death
AU - Audibert, Gérard
AU - Charpentier, Claire
AU - Seguin-Devaux, Carole
AU - Charretier, Pierre Alain
AU - Grégoire, Hélène
AU - Devaux, Yvan
AU - Perrier, Jean François
AU - Longrois, Dan
AU - Mertes, Paul Michel
PY - 2006/10
Y1 - 2006/10
N2 - 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.
AB - 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.
KW - Autonomic storm
KW - Brain death
KW - Heart transplantation
UR - http://www.scopus.com/inward/record.url?scp=33750368582&partnerID=8YFLogxK
UR - https://pubmed.ncbi.nlm.nih.gov/17060850
U2 - 10.1097/01.tp.0000235825.97538.d5
DO - 10.1097/01.tp.0000235825.97538.d5
M3 - Article
C2 - 17060850
AN - SCOPUS:33750368582
SN - 0041-1337
VL - 82
SP - 1031
EP - 1036
JO - Transplantation
JF - Transplantation
IS - 8
ER -