A stroke volume-based fluid resuscitation protocol decreases vasopressor support and may increase organ yield in brain-dead donors.

Abstract

Brain-dead donors are frequently hypovolemic and hypotensive requiring vasopressor support. We studied a stroke volume-based fluid resuscitation and vasopressor weaning protocol prospectively on 64 hypotensive donors, with a recent control cohort of 30 hypotensive donors treated without a protocol. Stroke volume was measured every 30minutes for 4hours by pulse contour analysis or esophageal Doppler. A 500mL saline fluid bolus was infused over 30minutes and repeated if the stroke volume increased by 10%. No fluid was infused if the stroke volume did not increase by 10%. Vasopressors were weaned every 10minutes if the mean arterial pressure was greater than 65mmHg. The protocol group received 1937±906mL fluid compared to 1323±919mL in the control group (P=.003). Mean time on vasopressors was decreased from 957.6±586.2 to 176.3±82.2minutes (P<.001). Donors in the protocol group were more likely to donate four or more organs than donors in the control group (OR=4.114, 95% Confidence Interval (CI)=1.003-16.876). While more organs were transplanted per donor in the protocol group (3.39±1.52) than in the control group (2.93±1.44) (P=.268), the difference did not reach statistical significance. A goal-directed fluid resuscitation protocol decreased organ ischemia and may increase organs transplanted.