Transcranial Doppler ultrasound in the diagnosis of brain death. Is it useful or does it delay the diagnosis?

Escudero, D.; Otero, J; Quindós, B.; Viña, L.

doi:10.1016/j.medine.2014.11.002

Cited by 9 publications

(7 citation statements)

References 31 publications

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“…In most studies, TCD is performed blindly without brain imaging, and proper positioning on the acoustic window cannot be elucidated. In adults, inadequacy of an acoustic window has been estimated to be between 10% and 20%, resulting in loss of a flow signal 11 . Loss of a flow signal can result from highly elevated ICP or an inadequate acoustic window.…”

Section: Discussionmentioning

confidence: 99%

“…In adults, inadequacy of an acoustic window has been estimated to be between 10% and 20%, resulting in loss of a flow signal. 11 Loss of a flow signal can result from highly elevated ICP or an inadequate acoustic window. Loss of flow signal in case of insufficient bone window is not a false positive finding, but just a condition that does not allow sonographic verification of brain death.…”

Section: Ta B L E 1 Cause Of Deathmentioning

confidence: 99%

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Use of duplex echoencephalography to evaluate brain death in children: A novel approach to the diagnosis

Sharma

Sheikh

Maertens

2022

Journal of Neuroimaging

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Background andPurpose: Brain death is defined as the irreversible cessation of brain function with a known etiology. This study aims to establish the value of duplex echoencephalography (DEG) in children fulfilling clinical brain death diagnostic criteria. Methods: DEG must show intracranial brain structures. Power Doppler is used to assess venous flow when feasible. Color Doppler patterns in all major arteries are assessed. Spectral analysis of arterial flow is divided into four grades: grade 1: inverted flow during entire diastole with time average peak velocity (TAPV) less or equal to zero; grade 2: disappearance of the inverted diastolic flow at the end of diastole; grade 3: oscillating pattern in early diastole; and grade 4: no diastolic flow with systolic blip. To fulfill diagnosis of brain death, brain perfusion must be lost for 30 minutes.Results: DEG is performed in 41 pediatric patients. In infants, loss of venous flow occurs regardless of the etiology. Grade 1 is the most common arterial color flow pattern and TAPV is always below zero. A pulsatile color flow is associated with three other types of flow patterns (grades 2-4). TAPV is not calculated, when there is loss of diastolic flow.Diagnosis of brain death is validated using nuclear brain scan in 4 patients. Two have a grade 1 flow pattern, while the other two have a grade 4 flow pattern. Conclusions:In children, DEG following a strict protocol can be used to confirm diagnosis of brain death in the appropriate clinical setting.

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Section: Discussionmentioning

confidence: 99%

Section: Ta B L E 1 Cause Of Deathmentioning

confidence: 99%

Use of duplex echoencephalography to evaluate brain death in children: A novel approach to the diagnosis

Sharma

Sheikh

Maertens

2022

Journal of Neuroimaging

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“…32 Cerebral blood flow may still be detected in clinically brain-dead patients with open skulls or with anoxia as the cause of death. 35 There have also been several false positives in the literature where reversal of diastolic flow was observed during increased ICP. 36 This gives further credence to performing multiple exams 30 minutes apart.…”

Section: Transcranial Doppler Ultrasoundmentioning

confidence: 99%

Ancillary Studies in Evaluating Pediatric Brain Death

Henderson

McDonald

2017

J Pediatr Intensive Care

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When confounding variables exist that inhibit the ability to diagnose brain death clinically in pediatric patients, ancillary tests may provide additional information for the practitioner in evaluating for the presence or absence of brain death. Multiple options exist but differ in availability, ease of administration, cost, safety profile, and reliability to accurately diagnose brain death. An important desirable quality of an ancillary test is eliminating false positives, which imply brain death when brain death is in fact not present. More commonly available ancillary studies include electroencephalograms, brain angiography through various modalities, brain stem auditory evoked potentials, and transcranial Doppler ultrasound. At this time, there is not an ancillary test with 100% reliability in diagnosing brain death that can replace the clinical brain death exam. Therefore, practitioners need to understand the strengths and limitations of the ancillary studies available at their hospital.

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“…Were the authors able to identify whether this was carried out as a legal requirement or whether specifically at the direction of the treating physician? The determination of brainstem death using clinical criteria is widely accepted as the gold standard, but the place of ancillary testing is yet to be fully determined [3], which is why UK national guidance does not mandate it [4]. Do the authors have data on how often a clinical diagnosis of brain death was refuted on the basis of ancillary testing in their dataset?…”

mentioning

confidence: 99%

“…These tests are usually performed by the responsible doctor, complemented by clinical examination. If the patient has been treated with high doses of sedatives/barbiturates, it is then mandatory to demonstrate cerebral circulatory arrest by means of ancillary tests that study cerebral blood flow, such as four-vessel cerebral arteriography, cerebral angiography by cranial computerised tomography (CT), cerebral angiogammagraphy with Tc99-HMPAO or transcranial Doppler [2][3][4][5][6][7][8].…”

mentioning

confidence: 99%