Prolonged hemodynamic maintenance by the combined administration of vasopressin and epinephrine in brain death: a clinical study.

Abstract

The present study attempted long term hemodynamic maintenance in 16 adult brain-dead patients, 14 with head injury and 2 with cerebrovascular accidents. In addition to respiratory and fluid management, 10 were treated with continuous infusion of epinephrine to maintain systolic blood pressure above 90 mm Hg. The remaining 6 patients each received a continuous infusion of synthetic arginine vasopressin (ADH) at a rate of 1 or 2 units/hour (285 +/- 45 microunits/kg/minute) simultaneously with epinephrine. The 10 patients treated with epinephrine alone all succumbed to cardiac arrest within 48 hours of brain death, with a mean survival time of 24.1 +/- 17.2 hours. In the patients who received simultaneous ADH infusion, a minimal dose of epinephrine of no more than 0.5 mg/hr in most instances sufficed to maintain blood pressure. Their mean survival time after brain death was remarkably prolonged to 23.1 +/- 19.1 days. In brain death, ADH plays a critical role in hemodynamic maintenance, and ADH administration permits long term hemodynamic stabilization of brain-death patients, offering increasing opportunities for organ transplantation.

• Authors: T Yoshioka, H Sugimoto, M Uenishi, T Sakamoto, D Sadamitsu, T Sakano, T Sugimoto
• Journal: Neurosurgery (Neurosurgery) Vol. 18 Issue 5 Pg. 565-7 (May 1986) ISSN: 0148-396X [Print] United States
• PMID: 3714004 (Publication Type: Journal Article)

Chemical References

• Arginine Vasopressin
• Epinephrine

Topics

• Adolescent
• Adult
• Aged
• Arginine Vasopressin (therapeutic use)
• Blood Pressure
• Brain Death
• Brain Injuries (physiopathology)
• Cardiac Output
• Cerebrovascular Disorders (physiopathology)
• Epinephrine (therapeutic use)
• Female
• Heart Arrest (etiology, prevention & control)
• Hemodynamics
• Humans
• Male
• Middle Aged
• Myocardial Contraction
• Vascular Resistance