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Improvement of donor myocardial function after treatment of autonomic storm during brain death
Gérard Audibert1, Claire Charpentier, Carole Seguin-Devaux
1Service d'Anesthésie-Réanimation, Centre Hospitalier Universitaire de Nancy, Nancy, France.
Insights
Autonomic storm (AS) in organ donors causes myocardial dysfunction, but treatment improves heart function and increases successful cardiac transplants. This study evaluated AS incidence and treatment effects in human organ donors.
Area of Science:
- Cardiology
- Neurosurgery
- Transplantation Medicine
Background:
- Autonomic storm (AS) in brain death models causes myocardial dysfunction.
- Pharmacologic treatment can attenuate this dysfunction.
- The study investigated AS in human organ donors.
Purpose of the Study:
- Determine the incidence of AS in human organ donors.
- Evaluate the impact of AS treatment on myocardial function.
- Assess the effect of AS treatment on cardiac harvesting and transplantation success.
Main Methods:
- 152 patients were analyzed; 46 were potential cardiac donors.
- AS defined by systolic pressure > 200 mm Hg and tachycardia > 140 bpm.
- Heart acceptance evaluated using CK, troponin Ic, and LVEF via echocardiography.
Main Results:
- AS occurred in 29 patients (63%).
- Treated AS patients showed significantly higher LVEFs (63.9%) compared to untreated (49.0%) and no AS (55.4%).
- AS treatment was linked to increased successful cardiac transplantation probability (OR = 8.8).
Conclusions:
- Treating hypertension during AS may reduce brain death-induced myocardial dysfunction.
- AS treatment can increase the availability of cardiac grafts for transplantation.
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.
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