Evaluation of Cardiac Function in Patients with Brain Death using Advanced Hemodynamic Monitoring

Studies on hemodynamic changes in brain death are in vitro and in animal studies. And very few studies have been done on the hemodynamic changes of brain death. The aim of this study was to use advanced hemodynamic monitoring with echocardiography for evaluation of donated heart and to evaluate the moment by moment brain death patients with advanced hemodynamic monitoring tools and its effect on organ donation outcome.

This cross-sectional analytical study was performed on the patients with brain death who were candidates for organ donation in Dr. Masih Daneshvari Hospital between 2017 and 2019. Forty-two patients with brain death who were candidate for heart donation were evaluated using purposive sampling. After echocardiography and initial evaluation, these patients were evaluated using advanced hemodynamic monitoring tools and the required data were collected and recorded.

In echocardiography, Left Ventricle Size (LVS) was normal in 100% of patients and Left Ventricle Function (LVF) in 87.5%. Left Ventricle Ejection Fraction (LVEF) was less than 50% in 12.5% and in 87.5% it was more than 50%. In 50% of patients at baseline, peripheral vascular resistance (Systemic Vascular Resistance-SVR) was lower than 1200 and at the end of study it raised to 54.4%. Cardiac Index (CI) was lower than 2.4 in 16.7% of patients at baseline and 25% at the end of study. Decreased CI and decreased vascular resistance in patients with Ejection Fraction (EF) less than 50% were also significantly higher than in patients with EF above 50%.

Due to the extensive pathological changes that brain death has on the cardiovascular system, advanced hemodynamic monitoring can continuously manage inotropic drugs in these patients, decide to manage intravascular volume and ultimately stabilize hemodynamic and prevent destruction.