Einsatz der CT-Angiographie zur Feststellung des zerebralen Zirkulationsstillstandes

Lanfermann, Heinrich; Götz, Friedrich; Raab, Peter

doi:10.1007/s00062-015-0454-3

Cited by 9 publications

(4 citation statements)

References 17 publications

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“…New-generation multi-slice CT scanners are suitable to visualize vasculature and perfusion of the whole brain with a single intravenous injection of iodinated contrast medium to verify cerebral perfusion stop. National guidelines introduced CTA in several countries e.g., Austria, Canada, Croatia, France, Germany, Netherlands, Poland or Switzerland [ 26 , 29 , 39 , 40 ].…”

Section: Ancillary Tests For Determination Of Cerebral Blood Perfusio...mentioning

confidence: 99%

Computed Tomography Angiography (CTA) in Selected Scenarios with Risk of Possible False-Positive or False-Negative Conclusions in Diagnosing Brain Death

Schwarz

Errath

Delgado

et al. 2022

Life

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It is widely accepted that brain death (BD) is a diagnosis based on clinical examination. However, false-positive and false-negative evaluation results may be serious limitations. Ancillary tests are used when there is uncertainty about the reliability of the neurologic examination. Computed tomography angiography (CTA) is an ancillary test that tends to have the lowest false-positive rates. However, there are various influencing factors that can have an unfavorable effect on the validity of the examination method. There are inconsistent protocols regarding the evaluation criteria such as scoring systems. Among the most widely used different scoring systems the 4-point CTA-scoring system has been accepted as the most reliable method. Appropriate timing and/or Doppler pre-testing could reduce the number of possible premature examinations and increase the sensitivity of CTA in diagnosing cerebral circulatory arrest (CCA). In some cases of inconclusive CTA, the whole brain computed tomography perfusion (CTP) could be a crucial adjunct. Due to the increasing significance of CTA/CTP in determining BD, the methodology (including benefits and limitations) should also be conveyed via innovative electronic training tools, such as the BRAINDEXweb teaching tool based on an expert system.

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Section: Ancillary Tests For Determination Of Cerebral Blood Perfusio...mentioning

confidence: 99%

Computed Tomography Angiography (CTA) in Selected Scenarios with Risk of Possible False-Positive or False-Negative Conclusions in Diagnosing Brain Death

Schwarz

Errath

Delgado

et al. 2022

Life

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“…Alle Verfahren, die nach klinischer Feststellung der Symptome des Hirnfunktionsausfalls zum Nachweis des zerebralen Zirkulationsstillstands richtliniengemäß zum Einsatz kommen, haben bei korrekter und vollständiger Durchführung nach heutigem Kenntnisstand eine 100 %ige Spezifität [33,44,45,46].…”

Section: Vorgehen Bei Widersprüchlichen Befunden Der Apparativen Zusaunclassified

Feststellung des irreversiblen Hirnfunktionsausfalls gemäß der neuen Richtlinie

Brandt¹,

Walter²,

Schreiber³

2017

Neuroradiol Scan

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The state of final, irreversible cessation of the total function of the cerebrum, the brain stem, and the cerebellum (brain death) can only be diagnosed according to strict guidelines. In June 2015, the German Medical Association (Bundes?rztekammer ? B?K) updated its guideline for the preconditions and procedures to diagnose brain death according to the transplantation law (??16 Abs.?1). This was the 4th update since 1982, aiming at a further standardization of a highly structured and precise diagnostic process. This stepwise process is similar in most countries and consists of 1. the determination of required preconditions, 2. determination of clinical symptoms, i.?e. deep coma, absence of brainstem reflexes and apnea and 3. proof of irreversibility of brain function cessation. The present contribution aims to summarize the novel issues of the guideline such as the required qualification of the two independent examiners, the implementation of standard operating procedures, the detailed documentation standards, the age and etiology dependent diagnostic algorithms as well as the validity of new ancillary tests for the proof of irreversibility (e.?g. CT-angiography). This article draws particular attention to frequently asked questions that might occur in the practical implementation of the guideline.

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“…Lebensjahr zugelassen. Allerdings hat auch bei Kindern der Nachweis eines zerebralen Zirkulationsstillstandes eine relevante prognostische Bedeutung [21]. Bei jeder Gabe von Kontrastmitteln sind die bekannten Vorsichtsmaßnah-men zum Schutze des Patienten einzuhalten.…”

Section: Auswerteparameter Sind Standardisiertunclassified

Angiographische Verfahren zur Feststellung des zerebralen Zirkulationsstillstandes

Lanfermann

2016

Nervenarzt

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In several European countries catheter angiography is permitted as a confirmatory procedure for the determination of irreversible loss of brain function (brain death). In Germany catheter angiography requires the possibility of a therapeutic implication as a prerequisite. In the updated German guidelines computed tomography angiography (CTA) has been accredited as a new confirmatory procedure if a standardized protocol and predefined assessment parameters are adhered to. The CTA can be performed within a few minutes, even in situations with unstable intensive care patients. Magnetic resonance (MR) angiography has not yet been adequately validated and is not permitted in Germany as a confirmatory procedure for the determination of irreversible loss of brain function.

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Einsatz der CT-Angiographie zur Feststellung des zerebralen Zirkulationsstillstandes

Cited by 9 publications

References 17 publications

Computed Tomography Angiography (CTA) in Selected Scenarios with Risk of Possible False-Positive or False-Negative Conclusions in Diagnosing Brain Death

Computed Tomography Angiography (CTA) in Selected Scenarios with Risk of Possible False-Positive or False-Negative Conclusions in Diagnosing Brain Death

Feststellung des irreversiblen Hirnfunktionsausfalls gemäß der neuen Richtlinie

Angiographische Verfahren zur Feststellung des zerebralen Zirkulationsstillstandes

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