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Decompressive craniectomy and brain death prevalence and mortality: 8-year retrospective review
C Pereyra1, L Benito Mori, P Schoon
1Intensive Care Unit of Hospital Interzonal General de Agudos Prof. Dr. Luis Güemes, Buenos Aires, Argentina. cfpereyra75@hotmail.com
Insights
Decompressive craniectomy (DC) improved survival rates in intensive care patients. However, this surgical intervention did not significantly alter the likelihood of developing brain death (BD) or cardiac arrest.
Area of Science:
- Neurosurgery
- Intensive Care Medicine
- Neurology
Background:
- Decompressive craniectomy (DC) is a long-standing surgical procedure aimed at reducing intracranial pressure.
- Increased cerebral blood flow post-DC may mitigate cerebral circulatory arrest and brain death (BD).
- Understanding the role of DC in the context of BD and overall mortality is crucial for neurocritical care.
Purpose of the Study:
- To investigate the prevalence of brain death (BD).
- To determine the utilization rates of decompressive craniectomy (DC).
- To analyze the evolution to BD in patients with versus without DC.
Main Methods:
- Retrospective, observational, cross-sectional study conducted in a single high-intensity center in Argentina (2003-2010).
- Inclusion criteria: Patients with Glasgow Coma Score ≤ 7 on admission or during ICU stay.
- Data analysis included causes of death (cardiac arrest, BD, undefined) and assessment of DC use and outcomes.
Main Results:
- A total of 698 patients were analyzed, with a global mortality rate of 60%.
- Traumatic brain injury (TBI) was the most common diagnosis (nearly 50%).
- The DC group (n=206) exhibited significantly lower mortality (48% vs. 65%, P < .001) but no significant difference in the frequency of BD development (24% vs. 26%, P = .72) compared to the no-DC group.
Conclusions:
- Decompressive craniectomy was associated with improved survival rates.
- The study found no significant influence of DC on the development of brain death.
- Prevalence of BD was lower than national registries, but DC did not modify BD evolution within this cohort.
Abstract:
Decompressive craniectomy (DC) is a surgical practice that has been used since the late 19th century. The cerebral blood flow increase after the performance of a DC can delay and even prevent the development of cerebral circulatory arrest and brain death (BD). We aimed to determine the prevalence of BD, the use of DC, and the evolution to BD with versus without DC. This retrospective, observational, cross-sectional study was performed in a single high-intensity center in Argentina from January 2003 to December 2010. Inclusion criteria were all patients with Glasgow Coma Score of at most 7 on admission or during their stay in the intensive care units. Exclusion criteria were patients with incomplete data. In cases of death, we assessed whether they fulfilled BD criteria or if the cause of death was a cardiac arrest (CA). The 698 patients considered for analysis showed a 60% (n = 418) global mortality rate. The causes were: CA (n = 270); BD (n = 108) and others considered to be "undefined," namely not assessed completely for the diagnosis of BD (n = 40). According to diagnosis category, traumatic brain injury (TBI) was largest (nearly 50%). The DC group (n = 206) showed significant differences regarding sex and diagnosis category versus no DC group. Mortality was significantly lower in this group (48% versus 65%, P < .001). No significant differences were observed comparing causes of death (CA, BD, or undefined). The use of DC did not influence the frequency of BD development (24% versus 26%, P = .72). The average DC rate was 30% and of BD 16%. The prevalence of DC and better survival were recorded compared with subjects without DC. The prevalence of BD was lower than expected in accordance with national registries; however, among our group, DC did not seem to modify the evolution to BD.
