The effects of hormone resuscitation on cardiac function and hemodynamics in a porcine brain-dead organ donor model. 
We compared the effects of hormone resuscitation (HR) with a norepinephrine-based protocol on cardiac function, hemodynamics and need for vasopressor support after brain death in a porcine model.  Following brain death induction, animals were treated with norepinephrine and fluids for 3 h. In the following 3 h, they continued on norepinephrine and fluids (control) or received additional HR (triiodothyronine, methylprednisolone, vasopressin, insulin).  Data were collected pre-brain death, 3 and 6 h post-brain death.  At 6 h, median norepinephrine use was higher in controls (0.563 vs. 0 microg/kg/min; p < 0.005), with 6/8 HR animals weaned off norepinephrine compared with 0/9 controls.  Mean arterial pressure was higher in HR animals at 6 h (74 +/- 17 vs. 54 +/- 14 mmHg; p < 0.05).  Cardiac contractility was also significantly higher in HR animals at 6 h (stroke work index 1.777 vs. 1.494).  After collection of 6 h data, all animals were placed on the same low dose of norepinephrine.  At 6.25 h, HR animals had higher stroke work (3540 +/- 1083 vs. 1536 +/- 702 mL.mmHg; p < 0.005), stroke volume (37.2 +/- 8.2 vs. 21.5 +/- 9.8 mL; p < 0.01) and cardiac output (5.8 +/- 1.4 vs. 3.2 +/- 1.2 L/min; p < 0.005).  HR in a porcine model of brain death reduces norepinephrine requirements, and improves hemodynamics and cardiac function.  These results support the use of HR in the management of the brain-dead donor.