Noradrenaline Use in the Human Donor and Relationship with Load-Independent Right Ventricular Contractility

Abstract

Experimental and clinical studies suggest that brain death (BD)-associated cardiac dysfunction is related to the neurohormonal storm and subsequent exposure to intravenous catecholamines. We aimed to describe the relationship between empirical noradrenaline treatment and donor heart function, described for the first time with load-independent indices of right ventricular contractility. Twenty-seven BD patients were divided in three groups based on noradrenaline at time of offer, started by the donor hospital: group 1=no noradrenaline (n=11); group 2=low dose (n=8); group 3=high dose (n=8). After protocol-guided optimization by our retrieval team using a Swan-Ganz catheter, pressure-volume data were obtained from the right ventricle. Ten patients undergoing coronary revascularization served as controls. Twenty hearts were transplanted, seven of them as heart and lung blocks. Right ventricular end-systolic elastance (E(es)) was lower in BD donors compared with controls (mean 0.28 vs. 0.46 mm Hg/mL, P< or =0.01). There was no difference in terms of Swan-Ganz derived data between the BD subgroups, but E(es) was lower in groups 2 and 3 (P=0.04). Eight patients died within a year (four from graft failure), and they had a donor heart E(es) significantly lower than that of survivors (mean 0.20 vs. 0.33 mm Hg/mL, P=0.01). Hearts from BD donors have subclinical right ventricular impairment in contractility. E(es), a load-independent measure of contractile function, seems to be inversely correlated with empirical use of noradrenaline in the donor and with recipient survival at 1 year. This has implications for refining donor selection and management.