Research Article

Cardiac Function in Brain Death, Usage of Advanced Hemodynamic Monitoring


Background: This study used advanced hemodynamic monitoring along with simultaneous echocardiography to assess donated heart function of brain death patients using advanced hemodynamic monitoring and its efficacy in organ donation.
Methods: Forty-eight brain death patients who were candidates of heart donation on the basis of primary standard investigations were selected with purposive and convenient sampling methods. They were investigated with advanced hemodynamic monitoring after echocardiography and primary assessments and the gleaned data were recorded.
Results: Echocardiography showed that LVS (left ventricle size) and LVF (left ventricle function) were normal in %100 and %87.5 of patients, respectively. LVEF (left ventricle ejection fraction) was <%50 in %12.5 and >%50 in %87.5 of patients. SVR was smaller than 1200 at the beginning of the study that reached %54.4 at the end of the study. CI (cardiac index) was < 2.4 in %16.7 of the patients at the onset of the study that reached %25 at the end. Reduction of CI and SVR in patients with EF <%50 was significantly higher than that in patients with EF>%50.
Conclusion: Given the extensive pathological changes in the cardiovascular system exerted by brain death, advanced hemodynamic monitoring, if performed continually, can greatly aid in managing inotropic drugs in these patients, decision-making for managing intravascular volume, creating hemodynamic stability, and finally, preventing deterioration of function of the donated heart and loss of a donated organ.

[1] Hoy S, Frisbee J. Common Postoperative Heart Transplant Complications. Crit Care Nurs Q. 2018;41(4):383-8.
[2] Freeman R, Koerner E, Clark C, Halabicky K. Cardiac transplant postoperative management and care. Crit Care Nurs Q. 2016; 39(3): 214-26.
[3] Khan ME, Tutun S. Understanding and Predicting Organ Donation Outcomes Using Network-based Predictive Analytics. Procedia Computer Science. 2021; 185:185-92.
[4] Zaroff JG, Babcock WD, Shiboski SC. The impact of left ventricular dysfunction on cardiac donor transplant rates. J Heart Lung Transplant. 2003; 22(3):334-7.
[5] Stern LK, Velleca A, Nishihara K, Shen A, Zaliznyak M, Patel J, et al. Impact of the United Network for organ sharing 2018 donor heart allocation system on transplant morbidity and mortality. Clin Transplant. 2021; 35(2): e14181.
[6] Smits JM, De Pauw M, de Vries E, Rahmel A, Meiser B, Laufer G, et al. Donor scoring system for heart transplantation and the impact on patient survival. J Heart Lung Transplant. 2012; 31(4):387-97.
[7] Aliabadi-Zuckermann AZ, Gökler J, Kaider A, Riebandt J, Moayedifar R, Osorio E, et al. Donor heart selection and outcomes: An analysis of over 2,000 cases. J Heart Lung Transplant. 2018;37(8):976-84.
[8] Yoshikawa MH, Rabelo NN, Welling LC, Telles JPM, Figueiredo EG. Brain death and management of the potential donor. Neurol Sci. 2021:1-12.
[9] Zirpe K, Gurav S. Brain death and management of potential organ donor: an Indian perspective. Indian J Crit Care Med. 2019;23(Suppl 2):S151.
[10] Srivastava V, Nakra M, Datta R. Optimal management of brain-dead organ donor. Medical Journal Armed Forces India. 2021;77(1):1-5.
[11] Victorino JP, Mendes KDS, Westin ÚM, Magro JTJ, Corsi CAC, Ventura CAA. Perspectives toward brain death diagnosis and management of the potential organ donor. Nurs Ethics. 2019; 26(6):1886-96.
[12] Veeralakshmi A, Singh RK. Brain Death and Care of Organ Donor. International J Emergency and Trauma Nursing. 2020;6(2):1-5.
[13] YazdiMoghaddam H, Manzari Z-S, Mohammadi E. Nurses' challenges in caring for an organ donor brain dead patient and their solution strategies: A systematic review. Iran J Nurs Midwifery Res. 2020; 25(4):265-72.
[14] McCulloch MA, Zuckerman WA, Möller T, Knecht K, Lin KY, Beasley GS, et al. Effects of donor cause of death, ischemia time, inotrope exposure, troponin values, cardiopulmonary resuscitation, electrocardiographic and echocardiographic data on recipient outcomes: a review of the literature. Pediatr Transplant. 2020; 24(3):e13676.
[15] Rohrig SAH. Role of the intensivist for organ donation. Qatar Med J. 2020; 2019(2-Qatar Critical Care Conference Proceedings):12.
[16] Madan S, Saeed O, Vlismas P, Katsa I, Patel SR, Shin JJ, et al. Outcomes after transplantation of donor hearts with improving left ventricular systolic dysfunction. J Am Coll Cardiol. 2017;70(10):1248-58.
[17] Tong CK, Khush KK. New Approaches to Donor Selection and Preparation in Heart Transplantation. Curr Treat Options Cardiovasc Med. 2021; 23(5):28.
[18] Zaroff JG, Rosengard BR, Armstrong WF, Babcock WD, D’Alessandro A, Dec GW, et al. Consensus conference report: maximizing use of organs recovered from the cadaver donor: cardiac recommendations: March 28–29, 2001, Crystal City, Va. Circulation. 2002; 106(7):836-41.
[19] Grafton G, Samoukovic G, Colvin MM. Cardiac Donor Selection and Management. Current Transplantation Reports. 2015; 2(4):338-44.
[20] Sibona A, Khush KK, Oyoyo UE, Martens TP, Hasaniya NW, Razzouk AJ, et al. Long-term transplant outcomes of donor hearts with left ventricular dysfunction. J Thorac Cardiovasc Surg. 2019;157(5):1865-75.
[21] Oras J, Doueh R, Norberg E, Redfors B, Omerovic E, Dellgren G. Left ventricular dysfunction in potential heart donors and its influence on recipient outcomes. J Thorac Cardiovasc Surg. 2020; 159(4):1333-41. e6.
[22] Shah KS, Kittleson MM, Kobashigawa JA. Updates on heart transplantation. Curr Heart Fail Rep. 2019; 16(5):150-6.
[23] Bugge JF, Kerans V, Nyrerød HC, Halvorsen PS. Haemodynamic evaluation and optimisation of brain-dead donors with oesophageal Doppler during organ harvesting: A feasibility study. Eur J Anaesthesiol. 2018; 35(11): 893-5.
[24] Farmer BE, Zhukov IO. Anesthesia for Heart and Lung Transplantation. Anesthesiology: Springer; 2018. p. 31-40.
[25] Pradegan N, Toscano G, Gerosa G. Mending hearts: A further strategy to improve cardiac donors availability. J Card Surg. 2021; 36(8):2989-2991.
[26] Ciarka A, Page A, Messer S, Pavlushkov E, Tsui S, Parameshwar J, et al. Donation after circulatory death hearts recipients compared to donation after brain death heart recipients have comparable systolic left ventricular function and better myocardial strain at 1 year. European Heart Journal. 2020;41(Supplement_2):ehaa946. 1108.
[27] Guo J-Y, Fang M-X, Huang Q-S, Zhang H-W, Zhang L-X, Wang Z-Y. Hemodynamic analysis of brain death patients using pulse-induced contour cardiac output (PiCCO). Biomedical Research (0970-938X). 2017;28(15).
[28] Fonseca BSd, Souza VSd, Batista TOF, Silva GM, Spigolon DN, Derenzo N, et al. Strategies for hemodynamic maintenance of potential brain-dead donor: integrative review. Einstein (São Paulo). 2021; 19:eRW5630.
IssueVol 8 No 1 (2022): Winter QRcode
SectionResearch Article(s)
Echocardiography advanced hemodynamic monitoring organ donation heart donation. heart transplantation

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Jahangirifard A, Monjazebi F, Ilbeigi A, Naghdipour N, Ahmadi ZH, Sadegh Beigee F, Dehghani S. Cardiac Function in Brain Death, Usage of Advanced Hemodynamic Monitoring. Arch Anesth & Crit Care. 2022;8(1):29-35.