CT Angiography for Brain Death Diagnosis

Frampas, É.; Videcoq, M.; Kerviler, É. de; Ricolfi, F.; Kuoch, Viseth; Mourey, F.; Tenaillon, Alain; Dupas, B.

doi:10.3174/ajnr.a1614

Cited by 142 publications

(177 citation statements)

References 20 publications

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“…5,6 The protocol for CTA for the confirmation of brain death can vary considerably among different centers; this variation makes it difficult for it to be accepted as the criterion standard test. 7 The most acceptable study, which used 2 acquisitions of CTA after a single bolus of contrast injection, had a variation between the 2 acquisitions from 54 to 61 seconds.…”

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confidence: 99%

CT Perfusion for Confirmation of Brain Death

Shankar¹,

Vandorpe²

2012

AJNR Am J Neuroradiol

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SUMMARY:For pronouncing brain death, unlike CTP, the 2-phase CTA gives no functional information and is limited by inadvertent delay of the second acquisition, which may give false-negative results. The purpose of our study was to compare CTP and CTA derived from the CTP data with the Dupas and Frampas criteria for confirmation of brain death. A retrospective review of CTP in 11 consecutive patients for confirmation of brain death showed a sensitivity of 72.7% for 7-and 4-point scores, 81.8% for opacification of the ICV, and 100% for CTP scores in the brain stem. CTA obtained from the CTP data showed similar sensitivity in the diagnosis of brain death. This protocol also reduces the iodinated contrast dose and is less operator-dependent. The addition of the functional tools of CTP increased the sensitivity of CTA in the confirmation of brain death. ABBREVIATIONS:ACA ϭ anterior cerebral artery; ICU ϭ intensive care unit; ICV ϭ internal cerebral vein; STA ϭ superficial temporal artery; VOG ϭ great cerebral

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confidence: 99%

CT Perfusion for Confirmation of Brain Death

Shankar¹,

Vandorpe²

2012

AJNR Am J Neuroradiol

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“…Nachweis eines zerebralen Zirkulationsstillstandes durch fehlende Kontrastierung der intrakavernösen A. carotis interna beidseits (offener Pfeil) und der übrigen intraduralen Arterien bei guter Kontrastierung der A. temporalis superficialis beidseits und weiterer Externa-Äste (Pfeile). Die CTA wurde bisher ausschließlich für die Feststellung des zerebralen Zirkulationsstillstandes bei Erwachsenen validiert [3][4][5][6][7][8][9][10][11][12][13][14]. Bei klinischen Zeichen des irreversiblen Hirnfunktionsausfalles dürfte jedoch auch bei Kindern nach dem ersten Lebensjahr (geschlossene Fontanellen) der Nachweis des zerebralen Zirkulationsstillstandes mittels CTA ein relevanter prognostischer Indikator sein …”

Section: Wie Ist Die Cta Zur Feststellung Des Zerebralen Zirkulationsunclassified

Einsatz der CT-Angiographie zur Feststellung des zerebralen Zirkulationsstillstandes

2015

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“…If apnea testing is not tolerated by the patient, the results are inconclusive, or shorter intervals are required between initiation and completion of a brain death protocol, ancillary neurodiagnostic testing [26][27][28]36,38,[43][44][45][46][47][48][49][50][51][52][53][54][55][56] (Table 5) may be appropriate. Early use of adjunctive testing may decrease intervals between terminal brain stem herniation, declaration of brain death, and organ recovery for transplant, facilitating earlier hormonal resuscitation protocols and earlier organ recovery.…”

Section: Adjunctive Neurodiagnostic Testingmentioning

confidence: 99%

Brain Death: Assessment, Controversy, and Confounding Factors

Arbour

2013

Critical Care Nurse

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When brain injury is refractory to aggressive management and is considered nonsurvivable, with loss of consciousness and brain stem reflexes, a brain death protocol may be initiated to determine death according to neurological criteria. Clinical evaluation typically entails 2 consecutive formal neurological examinations to document total loss of consciousness and absence of brain stem reflexes and then apnea testing to evaluate carbon dioxide unresponsiveness within the brain stem. Confounding factors such as use of therapeutic hypothermia, high-dose metabolic suppression, and movements associated with complex spinal reflexes, fasciculations, or cardiogenic ventilator autotriggering may delay initiation or completion of brain death protocols. Neurodiagnostic studies such as 4-vessel cerebral angiography can rapidly document absence of blood flow to the brain and decrease intervals between onset of terminal brain stem herniation and formal declaration of death by neurological criteria. Intracranial pathophysiology leading to brain death must be considered along with clinical assessment, patterns of vital signs, and relevant diagnostic studies.

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CT Angiography for Brain Death Diagnosis

Cited by 142 publications

References 20 publications

CT Perfusion for Confirmation of Brain Death

CT Perfusion for Confirmation of Brain Death

Einsatz der CT-Angiographie zur Feststellung des zerebralen Zirkulationsstillstandes

Brain Death: Assessment, Controversy, and Confounding Factors

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