Krishnamoorthy Vijay, Borbely Xenia, Rowhani-Rahbar Ali, Souter Michael J, Gibbons Edward, Vavilala Monica S
1Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA. 2Harborview Injury Prevention and Research Center, Seattle, WA. 3Department of Epidemiology, University of Washington, Seattle, WA. 4Department of Cardiology, University of Washington, Seattle, WA.
Pediatr Crit Care Med. 2015 May;16(4):e107-12. doi: 10.1097/PCC.0000000000000397.
Cardiac dysfunction has been reported to occur in as much as 42% of adults with brain death, and may limit cardiac donation after brain death. Knowledge of the prevalence and natural course of cardiac dysfunction after brain death may help to improve screening and transplant practices but adequately sized studies in pediatric brain death are lacking. The aims of our study are to describe the prevalence and course of cardiac dysfunction after pediatric brain death.
Cross-sectional study.
SETTING/SUBJECTS: We examined an organ procurement organization database (Life Center Northwest) of potential pediatric cardiac donors diagnosed with brain death between January 2011 and November 2013.
Transthoracic echocardiograms were reviewed for cardiac dysfunction (defined as ejection fraction <50% or the presence of regional wall motion abnormalities). Descriptive statistics were used to analyze clinical characteristics and describe longitudinal echocardiogram findings in a subgroup of patients. We examined for heterogeneity between cardiac dysfunction with respect to cause of brain death.
We identified 60 potential pediatric cardiac donors (age ≤ 18 yr) with at least one transthoracic echocardiogram following brain death. Cardiac dysfunction was present in 23 patients (38%) with brain death. Mean ejection fraction (37.6% vs 62.2%) and proportion of procured hearts (56.5% vs 83.8%) differed significantly between the groups with and without cardiac dysfunction, respectively. Of the 11 subjects with serial transthoracic echocardiogram data, the majority of patients with cardiac dysfunction (73%) improved over time, leading to organ procurement. No heterogeneity between cardiac dysfunction and particular causes of brain death was observed.
The frequency of cardiac dysfunction in children with brain death is high. Serial transthoracic echocardiograms in patients with cardiac dysfunction showed improvement of cardiac function in most patients, suggesting that initial decisions to procure should not solely depend on the initial transthoracic echocardiogram examination results.
据报道，多达42%的脑死亡成年患者会出现心脏功能障碍，这可能会限制脑死亡后的心脏捐赠。了解脑死亡后心脏功能障碍的患病率和自然病程可能有助于改进筛查和移植操作，但缺乏针对小儿脑死亡的规模足够大的研究。我们研究的目的是描述小儿脑死亡后心脏功能障碍的患病率和病程。
横断面研究。
设置/研究对象：我们检查了一个器官获取组织数据库（西北生命中心），该数据库包含2011年1月至2013年11月期间被诊断为脑死亡的潜在小儿心脏捐赠者。
回顾经胸超声心动图以评估心脏功能障碍（定义为射血分数<50%或存在节段性室壁运动异常）。使用描述性统计分析临床特征，并描述一组患者的纵向超声心动图检查结果。我们检查了心脏功能障碍在脑死亡原因方面的异质性。
我们确定了60名潜在的小儿心脏捐赠者（年龄≤18岁），他们在脑死亡后至少进行了一次经胸超声心动图检查。23名（38%）脑死亡患者存在心脏功能障碍。有和没有心脏功能障碍的两组之间，平均射血分数（分别为37.6%和62.2%）以及获取心脏的比例（分别为56.5%和83.8%）存在显著差异。在11名有连续经胸超声心动图数据的受试者中，大多数心脏功能障碍患者（73%）随时间推移有所改善，从而能够进行器官获取。未观察到心脏功能障碍与特定脑死亡原因之间存在异质性。
脑死亡儿童心脏功能障碍的发生率很高。心脏功能障碍患者的系列经胸超声心动图显示大多数患者的心脏功能有所改善，这表明最初的获取决定不应仅取决于首次经胸超声心动图检查结果。
