MINISTRY OF EDUCATION AND TRAINING MINISTRY OF DEFENCE
108 INSTITUTE OF CLINICAL MEDICAL AND
PHARMACEUTICAL SCIENCES
DAO THI KIM DUNG
RESEARCH OF
RESUSCITATION EFFECTS TO ORGAN
FUNCTIONS IN BRAIN - DEAD POTENTIAL
DONORS
Speciality: ANESTHESIOLIGY
Code: 62720122
PhD. THESIS ABSTRACT
HA NOI– 2019
THIS WORK WAS COMPLETED AT 108 INSTITUTE OF
CLINICAL MEDICAL AND PHARMACEUTICAL SCIENCES
Scientific Supervisors:
Prof. PhD. Nguyen Quoc Kinh
Reviewer 1:
Reviewer2:
Reviewer 3:
The thesis is presented at the Council of 108 Institute of Clinical
Medical and Pharmaceutical Sciences at: …. h …. date / /2019
The thesis can be founded at:
1. Vietnam National Library
2. Library of 108 Institute of Clinical Medical and Pharmaceutical
Sciences.
3. Library of Viet Duc University Hospital
1
INTRODUCTION
1. The neccessary of the subject
Organ transplantation is the last -line treatment for patients with
end-stage organ failure which can help the patient to have a new life.
All over the world, the major problem is the shortage of donated
organes, numbers of donated organs only meet less than 10% of the
demand.
In Vietnam, the current estimate of all kinds organ donors only
meets 5% of transplant needs. In July 1
st
2007, Vietnamese parliament
has officially issued the “Law on donation, tissue and organ
transplants, donating the cadaver" No.75/2006/QH11.
Number of living donors is limited, therefore the main source of
organ transplantation is now cadaveric donors. But in reality, using
organs from cadaveric donors still has a lot of difficulties. Nearly all
of brain death patients suffer from organ failures and many of them
have multiple organ failures. Unadequate resuscitation can limite one
organ’s quality or even affect the whole body. Another way,
resuscitation of an organ can negatively affect another organ. This
process reduces the number of organs which can be used in
transplantation.
There are already some studies in Vietnam whose aims is
providing the protections for single organs, so in this study, we would
like to study a strategy of multiple organ resuscitation in the purpose
that we can maximize the number of organs which can be donnated.
So, we performed the study "Research of res uscitation effects
on organ functions in brain-dead potential donors" with 2
objectives:
1. Review clinical and laboratory characteristics in brain dead
potential organ donors.
2. Evaluate the effectiveness of resuscitation methods on the
2
functions of some organs in brain-dead potential donors.
2. The main new scientific contributions of the thesis
The thesis is the first study which evaluates the results of
formultiple organs resuscitation strategy in brain death potential
donors. From the results of this study, it is recommended to optimize
the hemodynamics to adequately perfusion of organs after brain death
to ensure the functions of the transplanted organs later;the organs
should be used in the 24 first hours frombeginning of organ
resuscitation (about 12 hours after the declaring of Brain-dead
diagnosis Council) because the organ functionsare is the best.
3. Structure of the thesis
The thesisconsists of 129 pages (introduction 2 pages, overview
37 pages, subjects and methods 25 pages, results 30 pages, dicussion
32 pages, conclusion 2 pages, and recommendation 1 page; with 37
tables, 23 images, 17 graphs and 1 figure. The thesis also used 160
references, 18 refs. in Vietnamsese and 142 refs. in English.
CHAPTER 1
OVERVIEW
1.1. Summary of anatomical and physiological characteristics of
the organs related to brain death
1.1.1. Summary of characteristics of the CNS related to brain death.
1.1.2. Summary of characteristics of the organs related to brain
death
1.1.3. Pathophysiology and complications of brain death
1.1.3.1. Pathophysiology of brain death: Changes of cardiovascular;
Changes in hepatic and coagulated function; Changes of neurology;
Changes of hormone; Activating of inflammatory response; Increasing
of cytokine after brain death; Endothelin axis; Effecting on the
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nervous - muscle system; Hypothermia.
1.1.3.2. Complications after brain death: unstable hemodynamics,
hypoxia, lack of circulation, increased blood osmotic pressure,
hyperglycemia, hypothermia, coagulopathy.
1.1.3.3. Electrolyte disorders after brain death: hypernatremia,
hypokalemia, hypoglycemia, hypocalcaemia, hypophosphatemia.
1.2. Several domestic and foreign studies on clinical and
laboratory characte ristics in brain-dead potential donors.
1.2.1. Brain death and brain death diagnosis in the world and in
Vietnam .
1.2.1.1. Definition: Brain death is defined as an “Irreversible cessation
of all functions of the entire brain, including the brainstem”
1.2.1.2. History.
In 1959, Mollaret - Goudon (France): mentioned "coma". In 1995,
the American Academy of Neurology (AAN) guideline: defined as
coma, absence of brainstem reflexes and apnoea - updated in 2010: A
patient determined to be brain dead is legally and clinical dead.
1.2.1.3. The diagnostic criteria of brain death in the world
UK (1976), France (1996), USA (1995) - updated (2010).
1.2.1.4. Criteria of brain death diagnosis of Vietnam
According to the "Law on donation, tissue and organ transplants,
donating the cadaver"and the Ministry of Health’s instruction
"Clinical and subclinical standards and cases of non-application of
clinical criteria to determine brain death".
1.2.2. Several studies on clinical and laboratory characteristics.
1.2.2.1. In the world: brain-dead patients have disorders such as
hypotension, coagulation disorders, diabetes mellitus, acidosis, kidney
failure, acute respiratory failure, the cause of brain death is stroke and