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Pharmacological normalization of circulation after acute brain death.

Steen, Stig LU ; Sjöberg, Trygve LU ; Liao, Qiuming LU ; Bozovic, Gracijela LU and Wohlfart, Björn LU (2012) In Acta Anaesthesiologica Scandinavica 56(8). p.1006-1012
Abstract
BACKGROUND:

Circulatory instability is a serious problem after brain death in organ donors. The hypotension is often counteracted with infusion of large amounts of crystalloid solutions, which may impair lung function leading to rejection of the lungs as donor organs. The aim was to show that the circulation can be normalized pharmacologically for 24 h in pigs after total removal of the brain and brainstem by decapitation (between C2 and C3).



METHODS:

Twenty-four 40-kg pigs (n = 8 × 3) were included: non-decapitated, decapitated, and decapitated with pharmacological treatment. All animals got the same basal fluid supply and ventilation. The pharmacological treatment consisted of the neuronal... (More)
BACKGROUND:

Circulatory instability is a serious problem after brain death in organ donors. The hypotension is often counteracted with infusion of large amounts of crystalloid solutions, which may impair lung function leading to rejection of the lungs as donor organs. The aim was to show that the circulation can be normalized pharmacologically for 24 h in pigs after total removal of the brain and brainstem by decapitation (between C2 and C3).



METHODS:

Twenty-four 40-kg pigs (n = 8 × 3) were included: non-decapitated, decapitated, and decapitated with pharmacological treatment. All animals got the same basal fluid supply and ventilation. The pharmacological treatment consisted of the neuronal monoamine reuptake blocker cocaine and low doses of noradrenaline and adrenaline. Desmopressin, triiodothyroxine, thyroxine and cortisol were also given.



RESULTS:

After decapitation, a catecholamine storm occurred, with an increase of noradrenaline and adrenaline by a factor of 79 and 298, respectively. Thirty minutes later, the pigs were hypotensive. The median time to the aortic pressure that was less than 40 mmHg was 9:09 h (range 5:50 to 22:01). After 6 h, the concentration of thyroid hormones and cortisol was significantly reduced. With pharmacological treatment of decapitated animals, the aortic pressure, renal blood flow, creatinine, urine production, liver function and blood gases did not differ significantly from the non-decapitated control animals.



CONCLUSION:

Pharmacological substitution of pituitary gland function, blockade of peripheral catecholamine neuronal reuptake and low doses of catecholamines normalize circulation in decapitated pigs throughout a 24-h observation period, whereas untreated decapitated pigs all develop severe circulatory collapse within 12 h. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Acta Anaesthesiologica Scandinavica
volume
56
issue
8
pages
1006 - 1012
publisher
Wiley-Blackwell
external identifiers
  • wos:000307437600008
  • pmid:22651688
  • scopus:84865120473
ISSN
0001-5172
DOI
10.1111/j.1399-6576.2012.02721.x
language
English
LU publication?
yes
id
7e6f46cb-e07f-486e-9531-d698152fff66 (old id 2859930)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/22651688?dopt=Abstract
date added to LUP
2012-07-04 11:17:46
date last changed
2017-07-23 04:54:13
@article{7e6f46cb-e07f-486e-9531-d698152fff66,
  abstract     = {BACKGROUND: <br/><br>
Circulatory instability is a serious problem after brain death in organ donors. The hypotension is often counteracted with infusion of large amounts of crystalloid solutions, which may impair lung function leading to rejection of the lungs as donor organs. The aim was to show that the circulation can be normalized pharmacologically for 24 h in pigs after total removal of the brain and brainstem by decapitation (between C2 and C3). <br/><br>
<br/><br>
METHODS: <br/><br>
Twenty-four 40-kg pigs (n = 8 × 3) were included: non-decapitated, decapitated, and decapitated with pharmacological treatment. All animals got the same basal fluid supply and ventilation. The pharmacological treatment consisted of the neuronal monoamine reuptake blocker cocaine and low doses of noradrenaline and adrenaline. Desmopressin, triiodothyroxine, thyroxine and cortisol were also given. <br/><br>
<br/><br>
RESULTS: <br/><br>
After decapitation, a catecholamine storm occurred, with an increase of noradrenaline and adrenaline by a factor of 79 and 298, respectively. Thirty minutes later, the pigs were hypotensive. The median time to the aortic pressure that was less than 40 mmHg was 9:09 h (range 5:50 to 22:01). After 6 h, the concentration of thyroid hormones and cortisol was significantly reduced. With pharmacological treatment of decapitated animals, the aortic pressure, renal blood flow, creatinine, urine production, liver function and blood gases did not differ significantly from the non-decapitated control animals. <br/><br>
<br/><br>
CONCLUSION: <br/><br>
Pharmacological substitution of pituitary gland function, blockade of peripheral catecholamine neuronal reuptake and low doses of catecholamines normalize circulation in decapitated pigs throughout a 24-h observation period, whereas untreated decapitated pigs all develop severe circulatory collapse within 12 h.},
  author       = {Steen, Stig and Sjöberg, Trygve and Liao, Qiuming and Bozovic, Gracijela and Wohlfart, Björn},
  issn         = {0001-5172},
  language     = {eng},
  number       = {8},
  pages        = {1006--1012},
  publisher    = {Wiley-Blackwell},
  series       = {Acta Anaesthesiologica Scandinavica},
  title        = {Pharmacological normalization of circulation after acute brain death.},
  url          = {http://dx.doi.org/10.1111/j.1399-6576.2012.02721.x},
  volume       = {56},
  year         = {2012},
}