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Published on: August 9, 2024
Clinical experience with transcranial Doppler ultrasonography as a confirmatory test for brain death: a retrospective
Deepak Sharma1, Michael J Souter, Anne E Moore
1Department of Anesthesiology & Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA.
Insights
Transcranial Doppler (TCD) confirmed brain death (BD) in many cases where clinical diagnosis was difficult. An abnormal TCD pattern may indicate a poor prognosis even if full BD criteria are not met.
Area of Science:
- Neurology
- Critical Care Medicine
- Diagnostic Imaging
Background:
- Transcranial Doppler (TCD) ultrasonography is a key test for confirming cerebral circulatory arrest (CCA), a marker of brain death (BD).
- Clinical diagnosis of BD can be challenging due to confounding factors.
- This study evaluates TCD's utility in confirming BD when clinical diagnosis is not feasible.
Purpose of the Study:
- To assess the practical utility of TCD in confirming brain death when clinical diagnosis is not possible.
- To identify reasons for TCD's inability to confirm brain death.
- To evaluate outcomes for patients not meeting TCD criteria for brain death.
Main Methods:
- Retrospective analysis of TCD waveforms and medical records from 2001-2007.
- Diagnosis of BD based on CCA criteria from the World Federation of Neurology.
- Assessment of patient outcomes and use of ancillary tests.
Main Results:
- TCD confirmed BD in 57% of 90 patients; it was inconclusive in 43%.
- No flow signals were seen in 8% on initial TCD; abnormal waveforms inconsistent with BD were noted in 35%.
- Of 19 patients with a CCA pattern but not meeting all BD criteria, 14 later met BD criteria or had cardiovascular death.
Conclusions:
- TCD effectively confirmed brain death in a significant proportion of patients with challenging clinical diagnoses.
- A cerebral circulatory arrest (CCA) pattern in major cerebral arteries may predict unfavorable outcomes, even without fulfilling all BD criteria.
Background:
Transcranial Doppler (TCD) ultrasonography to demonstrate cerebral circulatory arrest (CCA) is a confirmatory test for brain death (BD). The primary aim of this retrospective study was to evaluate the practical utility of TCD to confirm BD when clinical diagnosis was not feasible due to confounding factors. Secondary aims were to evaluate the reasons for inability of TCD to confirm BD and to assess the outcome of patients not brain dead according to the TCD criteria.
Methods:
TCD waveforms and medical records of all the patients examined to confirm suspected BD between 2001 and 2007, where clinical diagnosis was not possible, were analyzed. BD was diagnosed based on CCA criteria recommended by the Task Force Group on cerebral death of the Neurosonology Research Group of the World Federation of Neurology. Final outcome of patients and the use of other ancillary tests were noted.
Results:
Ninety patients (61 males), aged 40 ± 21 (range 3-84) years underwent TCD examination for confirmation of suspected BD. TCD confirmed BD in 51 (57%) patients and was inconclusive in 38 (43%), with no flow signals on the first examination in 7 (8%) patients and the waveform patterns in 31 (35%) being inconsistent with BD. Fourteen of the 19 patients who had CCA pattern in at least one artery but did not meet all the criteria for BD were subsequently found brain dead according to SPECT/clinical criteria or suffered cardiovascular death.
Conclusion:
Using the conventional criteria, TCD confirmed BD in a large proportion, of patients where clinical diagnosis could not be made. The presence of CCA pattern in one or more major cerebral artery may be prognostic of unfavorable outcome, even when BD criteria are not satisfied.
