Effects of hormonal supplements on the maintenance of cardiac function in potential donor patients after cerebral death

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Abstract
It is well-known that cardiac function in cerebrally dead patientsrapidly deteriorates, leaving the organ unfit for donation. This studyinvestigated whether or not cardiac function in patients with cerebraldeath can be maintained in a desirable condition with hormonalsupplementation. In studies of changes in hormones before and aftercerebral death, insulin, glucagon, triiodothyronine, thyroxine, cortisol,vasopressin, epinephrine, and norepinephrine values were measured with alapse of time after cerebral death. Among them, triiodothyronine andcortisol levels were markedly reduced after cerebral death; therefore,these two hormones were selected as hormonal supplements. The averageperiod from the judgment of cerebral death to cardiac arrest was 4.3 daysin 12 patients with no hormonal supplement (group I) and more than 11.5days in 4 patients with hormonal supplement (group II). This period forpatients in group II was significantly longer (p less than 0.05). In 2 ofthe group II patients the hormonal supplementation was discontinued at thefamily's request, and in the other 2 patients, it was discontinued becauseof proposed renal donation. Hemodynamic comparisons between the two groupsshowed that the mean arterial pressure and the left ventricular maximumdp/dt were significantly higher (p less than 0.01) as was the cardiac index(p less than 0.05) on the 3rd day after cerebral death in members of groupII. Thereafter, in group II, an excellent hemodynamic state was maintaineduntil hormonal supplements were discontinued. We conclude that thetriiodothyronine and cortisol supplements were effective in the maintenanceof cardiac function in patients after cerebral death.

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