Hypothermia in organ donation: A friend or foe?

Bellal Joseph, Mazhar Khalil, Viraj Pandit, Narong Kulvatunyou, Bardiya Zangbar, Andrew Tang, Terence OKeeffe, Kara Snyder, Donald J. Green, Lynn Gries, Randall S. Friese, Peter Rhee

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

BACKGROUND: Hypothermia is a known predictor of mortality in trauma patients; however, its impact on organ procurement has not been defined. The aim of this study was to assess the effect of hypothermia on organ procurement. We hypothesized that admission hypothermia impedes successful organ procurement.

METHODS: We performed a 5-year retrospective analysis of all trauma patients approached for organ donation. Hypothermia was defined as a core body temperature 36°C/97°F or less. The two groups (hypothermic [HT] vs. nonhypothermic [non-HT]) were matched in a 1:1 ratio using propensity score matching for age, sex, admission Glasgow Coma Scale (GCS) score, systolic blood pressure, international normalized ratio, and Injury Severity Score (ISS). Primary outcome measures were eligibility for organ donation and solid organ procurement. Secondary outcome measures were blood product and vasopressor requirements.

RESULTS: This study was composed of 537 brain-dead patients, of whom 416 (HT, 208; non-HT, 208) were included in the analysis. The mean (SD) age was 40.5 (23.7) years, 75% were male, mean (SD) temperature was 36.6°C (1.7°C), and mean (SD) systolic blood pressure was 75.35 (68.7) mm Hg. Patients who were hypothermic on presentation were less likely to be eligible for organ donation (44.7% vs. 96%, p ≤ 0.001), and they donated fewer organs per donor (p = 0.04). HT patients required more units of fresh frozen plasma (p = 0.04) and greater mean dose of dopamine (p = 0.03) and vasopressin (p = 0.03) compared with the non-HT patients.

CONCLUSION: Admission hypothermia is associated with decreased organ donation in potential organ donors independent of admission coagulopathy, hypotension, and injury severity. Early correction of hypothermia may improve organ donation in trauma patients.

LEVEL OF EVIDENCE: Epidemiologic/prognostic study, level III.

Original languageEnglish (US)
Pages (from-to)559-563
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume77
Issue number4
DOIs
StatePublished - Oct 1 2014
Externally publishedYes

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Tissue and Organ Procurement
Hypothermia
Blood Pressure
Wounds and Injuries
Outcome Assessment (Health Care)
Tissue Donors
Propensity Score
Glasgow Coma Scale
Injury Severity Score
Brain Death
International Normalized Ratio
Body Temperature
Vasopressins
Hypotension
Epidemiologic Studies
Dopamine
Temperature
Mortality

Keywords

  • Brain-dead organ donors
  • Eligibility
  • Hypothermia
  • Solid organ donation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery
  • Medicine(all)

Cite this

Joseph, B., Khalil, M., Pandit, V., Kulvatunyou, N., Zangbar, B., Tang, A., ... Rhee, P. (2014). Hypothermia in organ donation: A friend or foe? Journal of Trauma and Acute Care Surgery, 77(4), 559-563. https://doi.org/10.1097/TA.0000000000000413

Hypothermia in organ donation : A friend or foe? / Joseph, Bellal; Khalil, Mazhar; Pandit, Viraj; Kulvatunyou, Narong; Zangbar, Bardiya; Tang, Andrew; OKeeffe, Terence; Snyder, Kara; Green, Donald J.; Gries, Lynn; Friese, Randall S.; Rhee, Peter.

In: Journal of Trauma and Acute Care Surgery, Vol. 77, No. 4, 01.10.2014, p. 559-563.

Research output: Contribution to journalArticle

Joseph, B, Khalil, M, Pandit, V, Kulvatunyou, N, Zangbar, B, Tang, A, OKeeffe, T, Snyder, K, Green, DJ, Gries, L, Friese, RS & Rhee, P 2014, 'Hypothermia in organ donation: A friend or foe?', Journal of Trauma and Acute Care Surgery, vol. 77, no. 4, pp. 559-563. https://doi.org/10.1097/TA.0000000000000413
Joseph B, Khalil M, Pandit V, Kulvatunyou N, Zangbar B, Tang A et al. Hypothermia in organ donation: A friend or foe? Journal of Trauma and Acute Care Surgery. 2014 Oct 1;77(4):559-563. https://doi.org/10.1097/TA.0000000000000413
Joseph, Bellal ; Khalil, Mazhar ; Pandit, Viraj ; Kulvatunyou, Narong ; Zangbar, Bardiya ; Tang, Andrew ; OKeeffe, Terence ; Snyder, Kara ; Green, Donald J. ; Gries, Lynn ; Friese, Randall S. ; Rhee, Peter. / Hypothermia in organ donation : A friend or foe?. In: Journal of Trauma and Acute Care Surgery. 2014 ; Vol. 77, No. 4. pp. 559-563.
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AU - Joseph, Bellal

AU - Khalil, Mazhar

AU - Pandit, Viraj

AU - Kulvatunyou, Narong

AU - Zangbar, Bardiya

AU - Tang, Andrew

AU - OKeeffe, Terence

AU - Snyder, Kara

AU - Green, Donald J.

AU - Gries, Lynn

AU - Friese, Randall S.

AU - Rhee, Peter

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N2 - BACKGROUND: Hypothermia is a known predictor of mortality in trauma patients; however, its impact on organ procurement has not been defined. The aim of this study was to assess the effect of hypothermia on organ procurement. We hypothesized that admission hypothermia impedes successful organ procurement.METHODS: We performed a 5-year retrospective analysis of all trauma patients approached for organ donation. Hypothermia was defined as a core body temperature 36°C/97°F or less. The two groups (hypothermic [HT] vs. nonhypothermic [non-HT]) were matched in a 1:1 ratio using propensity score matching for age, sex, admission Glasgow Coma Scale (GCS) score, systolic blood pressure, international normalized ratio, and Injury Severity Score (ISS). Primary outcome measures were eligibility for organ donation and solid organ procurement. Secondary outcome measures were blood product and vasopressor requirements.RESULTS: This study was composed of 537 brain-dead patients, of whom 416 (HT, 208; non-HT, 208) were included in the analysis. The mean (SD) age was 40.5 (23.7) years, 75% were male, mean (SD) temperature was 36.6°C (1.7°C), and mean (SD) systolic blood pressure was 75.35 (68.7) mm Hg. Patients who were hypothermic on presentation were less likely to be eligible for organ donation (44.7% vs. 96%, p ≤ 0.001), and they donated fewer organs per donor (p = 0.04). HT patients required more units of fresh frozen plasma (p = 0.04) and greater mean dose of dopamine (p = 0.03) and vasopressin (p = 0.03) compared with the non-HT patients.CONCLUSION: Admission hypothermia is associated with decreased organ donation in potential organ donors independent of admission coagulopathy, hypotension, and injury severity. Early correction of hypothermia may improve organ donation in trauma patients.LEVEL OF EVIDENCE: Epidemiologic/prognostic study, level III.

AB - BACKGROUND: Hypothermia is a known predictor of mortality in trauma patients; however, its impact on organ procurement has not been defined. The aim of this study was to assess the effect of hypothermia on organ procurement. We hypothesized that admission hypothermia impedes successful organ procurement.METHODS: We performed a 5-year retrospective analysis of all trauma patients approached for organ donation. Hypothermia was defined as a core body temperature 36°C/97°F or less. The two groups (hypothermic [HT] vs. nonhypothermic [non-HT]) were matched in a 1:1 ratio using propensity score matching for age, sex, admission Glasgow Coma Scale (GCS) score, systolic blood pressure, international normalized ratio, and Injury Severity Score (ISS). Primary outcome measures were eligibility for organ donation and solid organ procurement. Secondary outcome measures were blood product and vasopressor requirements.RESULTS: This study was composed of 537 brain-dead patients, of whom 416 (HT, 208; non-HT, 208) were included in the analysis. The mean (SD) age was 40.5 (23.7) years, 75% were male, mean (SD) temperature was 36.6°C (1.7°C), and mean (SD) systolic blood pressure was 75.35 (68.7) mm Hg. Patients who were hypothermic on presentation were less likely to be eligible for organ donation (44.7% vs. 96%, p ≤ 0.001), and they donated fewer organs per donor (p = 0.04). HT patients required more units of fresh frozen plasma (p = 0.04) and greater mean dose of dopamine (p = 0.03) and vasopressin (p = 0.03) compared with the non-HT patients.CONCLUSION: Admission hypothermia is associated with decreased organ donation in potential organ donors independent of admission coagulopathy, hypotension, and injury severity. Early correction of hypothermia may improve organ donation in trauma patients.LEVEL OF EVIDENCE: Epidemiologic/prognostic study, level III.

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KW - Eligibility

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