Technical Aids in the Diagnosis of Brain Death

Welschehold, Stefan; Boor, Stephan; Reuland, Katharina; Thömke, Frank; Kerz, Thomas; Reuland, Andre; Beyer, Christian; Gartenschläger, M; Wagner, W.; Giese, Alf; Müller‐Forell, Wibke

doi:10.3238/arztebl.2012.0624

Cited by 52 publications

(75 citation statements)

References 43 publications

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“…However, there are false positive and negative results and discrepancies between different tests. 11,12 The most important contribution of an additional imaging procedure is to reduce the time used in diagnosing brain death. 1 Additionally, imaging a perfused brain provides confidence for the decision of brain death.…”

Section: Discussionmentioning

confidence: 99%

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Güzel

Zp²,

Ha³

et al. 2014

Exp Clin Transplant

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Objectives: Brain scintigraphy with Tc-99m-labeled diethylenetriaminopenta-acetic acid is a sensitive diagnostic method showing loss of cerebral blood flow that occurs after brain death. Cerebral blood flow can be quantitatively estimated by this method. The aim of this study was to compare histopathologic changes occurring with the decrease of cerebral blood flow (as shown by Tc-99m-labeled diethylenetriaminopenta-acetic acid brain death scintigraphy) after brain death in an experimental model. Materials and Methods:The study included examination of cerebral blood flow by Tc-99m-labeled diethylenetriaminopenta-acetic acid brain scintigraphy in the 20 rats, 1 day before brain death, after producing brain death in 11 surviving rats. Tc-99m-labeled diethylenetriaminopenta-acetic acid brain scintigraphy was performed under intubation and monitored. The Mann-Whitney U test was performed to compare groups (scintigraphic quantification results before and after brain death). Results: In the time activity curves generated from the analysis of the scintigraphies, decreases in counts in the brain death group were obtained in the arterial phase (P < .01). Decreases of the cerebral blood flow between the first and the sixth minutes were statistically significant (P < .05). Common principal histopathologic changes of the brain death (ie, autolysis and color loss in the nerve cells, diffuse edema, petechial hemorrhage in the brain tissues) were observed in all subjects. Conclusions: Quantitative findings of the brain scintigraphy by Tc-99m-labeled diethylenetriaminopenta-acetic acid was related with the histopathologic findings seen during the early brain death, with significant decreases of the cerebral blood flow. Quantification of Tc-99m-labeled diethylenetriaminopenta-acetic acid brain death scintigraphy as an easier and less-expensive scintigraphic method of cerebral blood flow might indicate a definite diagnosis of brain death and thus, potential donors can be determined earlier, leading to increased transplant rates.

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Section: Discussionmentioning

confidence: 99%

Untitled

Güzel

Zp²,

Ha³

et al. 2014

Exp Clin Transplant

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“…In einem Cochrane Review [36] zum Einsatz der CTA zur Feststellung des irreversiblen Hirnfunktionsausfalles (international: "brain death") wurden bei den ausgewerteten CTA-Studien [2, 5, 10-12, 14,22,29,31,38] insbesondere die sehr heterogenen Untersuchungsprotokolle und Auswerteparameter bemängelt und eine Standardisierung gefordert. Dieser Empfehlung folgend sind mit den aktualisierten Richtlinien [4] zur Feststellung des irreversiblen Hirnfunktionsausfalles ein standardisiertes CTA-Protokoll und eine -im internationalen Vergleich -konservative Auswertung festgelegt worden (.…”

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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“…Dies entspricht auch den Empfehlungen eines Cochrane Reviews zu diesem Thema [3]. Das CTA-Protokoll wurde mit dem Ziel der maximalen Sicherheit erstellt und basiert auf den Parametern der bisher größten deutschen Studie zum Einsatz der CTA zur Feststellung des zerebralen Zirkulationsstillstandes [4]. Entsprechend den Auswertekriterien des Standardprotokolls sollten zur Feststellung des zerebralen Zirkulationsstillstandes -bei guter Kontrastierung der A. carotis communis, der A. carotis externa und der A. vertebralis Abb.…”

Section: Wie Ist Die Cta Zur Feststellung Des Zerebralen Zirkulationsunclassified

“…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