Bradycardia in donors may be sinus (ex. as part of Cushing’s triad), or non-sinus (ex. if the sinus node fails). Anticholinergics may not be effective if vagal nuclei have been compromised, thus direct-acting agents (ex. isoproterenol, a.k.a. Isuprel, 1.0 μg IV) are preferable. If isoproterenol is not available, consider dobutamine, epinephrine, or dopamine. External, transcutaneous pacing should be reserved for instances in which pharmacologic therapy fails. Occasionally, transvenous pacing may be necessary.
Organ Donor: Arrhythmia Treatment
- Bradycardia: isoproterenol (or dobutamine, epinephrine, or dopamine. Anticholinegics may not work)
- Sinus Tachycardia: esmolol
- SVT: adenosine
- Atrial Fibrillation: rate control (esmolol, diltiazem), likely no benefit for conversion (amiodarone)
- Non-Sustained PVCs: consider amiodarone
- Ventricular Fibrillation: defibrillation + 300 mg amiodarone
References
- David J Powner, Teresa A Allison Cardiac dysrhythmias during donor care. Prog Transplant: 2006, 16(1);74-80; quiz 81 PubMed Link
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