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Transcranial Doppler ultrasonography to confirm brain death: a meta-analysis
Louisa M Monteiro1, Casper W Bollen, Alexander C van Huffelen
1Department of Pediatric Intensive Care, University Medical Center Utrecht, Utrecht, AB, The Netherlands.
Insights
Transcranial Doppler ultrasonography (TCD) can reliably detect cerebral circulatory arrest (CCA), aiding in the diagnosis of brain death when other methods are precluded. This non-invasive technique shows high sensitivity and specificity for identifying fatal brain damage.
Area of Science:
- Neurology
- Diagnostic Imaging
- Critical Care Medicine
Background:
- Barbiturate therapy and hypothermia interfere with clinical and EEG assessments of brain death.
- Transcranial Doppler (TCD) ultrasonography can visualize intracranial flow patterns indicative of cerebral circulatory arrest (CCA).
Purpose of the Study:
- To evaluate the diagnostic accuracy of TCD in confirming brain death.
- To assess the validity of TCD findings for identifying cerebral circulatory arrest.
Main Methods:
- A systematic review and meta-analysis of English-language studies published between 1980 and 2004.
- Studies were assessed for quality using standardized criteria.
- Oscillating/reverberating flow and systolic spikes were defined as indicators of CCA.
Main Results:
- Ten studies (2 high-quality, 8 low-quality) were included.
- High-quality studies showed TCD sensitivity of 95% and specificity of 99% for brain death.
- All studies combined yielded a sensitivity of 89% and specificity of 99%.
Conclusions:
- TCD identification of CCA in anterior and posterior circulation predicts fatal brain damage.
- TCD can assist in timing angiography for brain death confirmation.
- Further research is needed to confirm TCD's predictive value for brain death on repeated examinations.
Objective:
Barbiturate therapy or hypothermia precludes proper diagnosis of brain death either clinically or by EEG. Specific intracranial flow patterns indicating cerebral circulatory arrest (CCA) can be visualized by transcranial Doppler ultrasonography (TCD). The aim of this study was to assess the validity of TCD in confirming brain death.
Design:
Meta-analysis of studies assessing the validity of TCD in confirming brain death.
Methods:
A systematic review of articles in English on the diagnosis brain death by TCD, published between 1980 and 2004, was performed. An oscillating or reverberating flow and systolic spikes were considered to be compatible with CCA. The quality of each study was assessed using standardized methodological criteria. The literature was searched for any article reporting a false-positive result.
Results:
Two high-quality and eight low-quality studies were included. Meta-analysis of the two high-quality studies showed a sensitivity of 95% (95% CI 92-97%) and a specificity of 99% (95% CI 97-100%) to detect brain death. Meta-analysis of all ten studies showed a sensitivity of 89% and a specificity of 99%. In the literature we found two false-positive results; however, in both patients brain-stem function did show brain death shortly thereafter.
Conclusions:
CCA by TCD in the anterior and posterior circulation predicted fatal brain damage in all patients; therefore, TCD can be used to determine the appropriate moment for angiography. Further research is needed to demonstrate that CCA by TCD on repeated examination can also predict brain death in all patients.
