Cardiovascular changes in the terminal stage of disease

In 11 patients with brain death, we measured cardiovascular parameters until cardiac arrest. After withdrawal of vasopressors, we observed marked falls in the cardiac output, systemic vascular resistance, heart rate and arterial pressure. In consequence, there was a marked decrease in oxygen delivery and the fall in arterial pressure established a vicious circle and circulatory death ensued. Most pronounced changes were left heart dysfunction and a fall in systemic vascular resistance. On the other hand, depression of the right side of the heart was half of that of left side, and the pulmonary circulation and volume status were well maintained until death. At the same time we found in these patients that body temperature and organ function except that of the brain were well maintained in brain dead patients. For resuscitation of apparently dead patients one must maintain not only cardiac functions but also systemic vascular functions.