Physiologic Changes in the Heart Following Cessation of Mechanical Ventilation in a Porcine Model of Donation After Circulatory Death: Implications for Cardiac Transplantation |
| |
| Authors: | C. W. White R. Lillico J. Sandha D. Hasanally F. Wang E. Ambrose A. Müller O. Rachid Y. Li B. Xiang H. Le S. Messer A. Ali S. R. Large T. W. Lee I. M. C. Dixon T. M. Lakowski K. Simons R. C. Arora G. Tian J. Nagendran L. V. Hryshko D. H. Freed |
| |
| Affiliation: | 1. Cardiac Surgery, University of Manitoba, Winnipeg, Canada;2. Institute of Cardiovascular Sciences, St. Boniface Research Center, Winnipeg, Canada;3. College of Pharmacy, University of Manitoba, Winnipeg, Canada;4. Faculty of Medicine, University of Alberta, Edmonton, Canada;5. National Research Council Institute for Biodiagnostics, Winnipeg, Canada;6. Department of Physiology, University of Alberta, Edmonton, Canada;7. Papworth Hospital, Cambridge, United Kingdom;8. Anesthesia and Perioperative Medicine, University of Manitoba, Winnipeg, Canada;9. Cardiac Surgery, University of Alberta, Edmonton, Canada;10. Department of Biomedical Engineering, University of Alberta, Edmonton, Canada |
| |
| Abstract: | Hearts donated following circulatory death (DCD) may represent an additional source of organs for transplantation; however, the impact of donor extubation on the DCD heart has not been well characterized. We sought to describe the physiologic changes that occur following withdrawal of life‐sustaining therapy (WLST) in a porcine model of DCD. Physiologic changes were monitored continuously for 20 min following WLST. Ventricular pressure, volume, and function were recorded using a conductance catheter placed into the right (N = 8) and left (N = 8) ventricles, and using magnetic resonance imaging (MRI, N = 3). Hypoxic pulmonary vasoconstriction occurred following WLST, and was associated with distension of the right ventricle (RV) and reduced cardiac output. A 120‐fold increase in epinephrine was subsequently observed that produced a transient hyperdynamic phase; however, progressive RV distension developed during this time. Circulatory arrest occurred 7.6±0.3 min following WLST, at which time MRI demonstrated an 18±7% increase in RV volume and a 12±9% decrease in left ventricular volume compared to baseline. We conclude that hypoxic pulmonary vasoconstriction and a profound catecholamine surge occur following WLST that result in distension of the RV. These changes have important implications on the resuscitation, preservation, and evaluation of DCD hearts prior to transplantation. |
| |
| Keywords: | basic (laboratory) research science organ transplantation in general heart transplantation cardiology organ procurement and allocation donation after circulatory death (DCD) critical care intensive care management porcine ischemia reperfusion injury (IRI) organ procurement |
|
|
