Skip to main content
Top
Published in: Neurological Sciences 1/2011

01-02-2011 | Original Article

The relevance of early TCD monitoring in the intensive care units for the confirming of brain death diagnosis

Authors: Marinella Marinoni, Fabiana Alari, Veronica Mastronardi, Adriano Peris, Paola Innocenti

Published in: Neurological Sciences | Issue 1/2011

Login to get access

Abstract

Brain death (BD) diagnosis is the clinical assessment of the irreversible loss of function of the entire brain, including the brainstem. Transcranial Doppler (TCD) examination is used in several countries as a confirmatory test to assess cerebral circulatory arrest (CCA). A total of 1,400 TCD examinations were performed in 623 patients (pts) admitted to intensive care units (ICUs) of our hospital during the last 6 years. Oscillating flow, systolic spikes and the absence of any TCD signal were considered as diagnostic patterns of irreversible CCA. TCD patterns of CCA were detected in 56 pts. In 25 pts, deeply sedated with barbiturate therapy, TCD was employed as confirmatory test for BD diagnosis and 14 of them could become organ and/or tissue donors. TCD is a safe and inexpensive tool that can be performed at the bedside, and it allows to shorten the diagnostic process of BD, which is the prerequisite for organ donation.
Literature
1.
go back to reference The Quality Standards Subcommittee of the American Academy of Neurology (1995) Practice parameters for determining brain death in adults (summary statement). Neurology 45(5):1012–1014 The Quality Standards Subcommittee of the American Academy of Neurology (1995) Practice parameters for determining brain death in adults (summary statement). Neurology 45(5):1012–1014
2.
go back to reference Wijdicks EF (2002) Brain death worldwide. Accepted fact but no global consensus in diagnostic criteria. Neurology 58:20–25PubMed Wijdicks EF (2002) Brain death worldwide. Accepted fact but no global consensus in diagnostic criteria. Neurology 58:20–25PubMed
3.
go back to reference German Chamber of Deputies (1997) Organ transplantation law: guidelines for the statement of cerebral death, vol 95, no 30. Bulletin of German Medical Association, pp 24 German Chamber of Deputies (1997) Organ transplantation law: guidelines for the statement of cerebral death, vol 95, no 30. Bulletin of German Medical Association, pp 24
4.
go back to reference Haupt WF, Rudolf J (1999) European brain death codes: a comparison of national guidelines. J Neurol 246:432–437CrossRefPubMed Haupt WF, Rudolf J (1999) European brain death codes: a comparison of national guidelines. J Neurol 246:432–437CrossRefPubMed
5.
go back to reference Naya MT, Miranda B, Fernandez-Zinke E, Caňòn J, Cuende N (2001) Analysis of the enforcement of New Royal Decree 2070/1999 on the methodology of brain death diagnosis for organ donation in year 2000. Rev Esp Trasp 11:1–21 Naya MT, Miranda B, Fernandez-Zinke E, Caňòn J, Cuende N (2001) Analysis of the enforcement of New Royal Decree 2070/1999 on the methodology of brain death diagnosis for organ donation in year 2000. Rev Esp Trasp 11:1–21
8.
go back to reference Sloan MA, Alexandrov AV, Tegeler CH, Spencer MP, Caplan LR, Feldmann E, Wechsler LR, Newell DW, Gomez CR, Babikian VL, Lefkowitz D, Goldman RS, Armon C, Hsu CY, Goodin DS (2004) Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Assessment: transcranial Doppler ultrasonography: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 62(9):1468–1481 Sloan MA, Alexandrov AV, Tegeler CH, Spencer MP, Caplan LR, Feldmann E, Wechsler LR, Newell DW, Gomez CR, Babikian VL, Lefkowitz D, Goldman RS, Armon C, Hsu CY, Goodin DS (2004) Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Assessment: transcranial Doppler ultrasonography: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 62(9):1468–1481
9.
go back to reference Calleja S, Tembl JI, Segura T (2007) Recommendations of the use of transcranial Doppler to determine the existence of cerebral circulatory arrest as diagnostic of brain death. Neurología 22(7):441–447PubMed Calleja S, Tembl JI, Segura T (2007) Recommendations of the use of transcranial Doppler to determine the existence of cerebral circulatory arrest as diagnostic of brain death. Neurología 22(7):441–447PubMed
10.
go back to reference Ducrocq X, Hassler W, Moritake K, Newell DW, von Reutern GM, Shiogai T, Smith RR (1998) Consensus opinion on diagnosis of cerebral circulatory arrest using Doppler-sonography: Task Force Group on cerebral death of the Neurosonology Research Group of the World Federation of Neurology. J Neurol Sci 159(2):145–150 Ducrocq X, Hassler W, Moritake K, Newell DW, von Reutern GM, Shiogai T, Smith RR (1998) Consensus opinion on diagnosis of cerebral circulatory arrest using Doppler-sonography: Task Force Group on cerebral death of the Neurosonology Research Group of the World Federation of Neurology. J Neurol Sci 159(2):145–150
11.
go back to reference Petty GW, Mohr JP, Pedley TA, Tatemichi TK, Lennihan L, Duterte DI, Sacco RL (1990) The role of transcranial Doppler in confirming brain death: sensitivity, specificity, and suggestions for performance and interpretation. Neurology 40(2):300–303PubMed Petty GW, Mohr JP, Pedley TA, Tatemichi TK, Lennihan L, Duterte DI, Sacco RL (1990) The role of transcranial Doppler in confirming brain death: sensitivity, specificity, and suggestions for performance and interpretation. Neurology 40(2):300–303PubMed
12.
go back to reference Babikian VL, Feldmann E, Wechsler LR, Newell DW, Gomez CR, Bogdahn U, Caplan LR, Spencer MP, Tegeler C, Ringelstein EB, Alexandrov AV (2000) Transcranial Doppler ultrasonography: year 2000 update. J Neuroimaging 10(2):101–115PubMed Babikian VL, Feldmann E, Wechsler LR, Newell DW, Gomez CR, Bogdahn U, Caplan LR, Spencer MP, Tegeler C, Ringelstein EB, Alexandrov AV (2000) Transcranial Doppler ultrasonography: year 2000 update. J Neuroimaging 10(2):101–115PubMed
13.
go back to reference Poularas J, Karakitsos D, Kouraklis A, Kostakis A, De Grott E, Kalogeromitros A, Bilalis D, Boletis J, Karabinis A (2006) Comparison between transcranial color Doppler ultrasonography and angiography in the confirmation of brain death. Trans Proceed 38:1213–1217CrossRef Poularas J, Karakitsos D, Kouraklis A, Kostakis A, De Grott E, Kalogeromitros A, Bilalis D, Boletis J, Karabinis A (2006) Comparison between transcranial color Doppler ultrasonography and angiography in the confirmation of brain death. Trans Proceed 38:1213–1217CrossRef
14.
go back to reference López-Navidad A, Caballero F, Domingo P, Marruecos L, Estorch M, Kulisevsky J, Mora J (2000) Early diagnosis of brain death in patients treated with central nervous system depressant drugs. Transplantation 70(1):131–135 López-Navidad A, Caballero F, Domingo P, Marruecos L, Estorch M, Kulisevsky J, Mora J (2000) Early diagnosis of brain death in patients treated with central nervous system depressant drugs. Transplantation 70(1):131–135
15.
go back to reference Aaslid R, Markwalder T-M, Nornes H (1982) Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg 57:769–774CrossRefPubMed Aaslid R, Markwalder T-M, Nornes H (1982) Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg 57:769–774CrossRefPubMed
16.
go back to reference Harders A (1986) Brain death and TCD recordings. In: Harders A (ed) Neurosurgical applications of transcranial Doppler sonography; Wien/New York: Springer-Verlag, pp 115–118 Harders A (1986) Brain death and TCD recordings. In: Harders A (ed) Neurosurgical applications of transcranial Doppler sonography; Wien/New York: Springer-Verlag, pp 115–118
17.
go back to reference Ropper AH, Kehne SM, Wechsler L (1987) Transcranial Doppler in brain death. Neurology 37:1733–1735PubMed Ropper AH, Kehne SM, Wechsler L (1987) Transcranial Doppler in brain death. Neurology 37:1733–1735PubMed
18.
go back to reference Hassler W, Steinmetz H, Pirschel J (1989) Transcranial Doppler study of intracranial circulatory arrest. J Neurosurg 71(2):195–201CrossRefPubMed Hassler W, Steinmetz H, Pirschel J (1989) Transcranial Doppler study of intracranial circulatory arrest. J Neurosurg 71(2):195–201CrossRefPubMed
19.
go back to reference Itoh T, Matsumoto M, Handa N, Maeda H, Hougaku H, Hashimoto H, Etani H, Tsukamoto Y, Kamada T (1993) Rate of successful recording of blood flow signals in the middle cerebral artery using transcranial Doppler sonography. Stroke 24:1192–1195PubMed Itoh T, Matsumoto M, Handa N, Maeda H, Hougaku H, Hashimoto H, Etani H, Tsukamoto Y, Kamada T (1993) Rate of successful recording of blood flow signals in the middle cerebral artery using transcranial Doppler sonography. Stroke 24:1192–1195PubMed
20.
go back to reference Marinoni M, Ginanneschi A, Forleo P, Amaducci L (1997) Technical limits in transcranial Doppler recording: inadequate acoustic windows. Ultrasound Med Biol 23(8):1275–1277CrossRefPubMed Marinoni M, Ginanneschi A, Forleo P, Amaducci L (1997) Technical limits in transcranial Doppler recording: inadequate acoustic windows. Ultrasound Med Biol 23(8):1275–1277CrossRefPubMed
21.
go back to reference Ducrocq X, Braun M, Debouviere M, Junges C, Hummer M, Vespignani H (1998) Brain death and transcranial Doppler: experience in 130 cases of brain death patients. J Neurol Sci 160:41–46CrossRefPubMed Ducrocq X, Braun M, Debouviere M, Junges C, Hummer M, Vespignani H (1998) Brain death and transcranial Doppler: experience in 130 cases of brain death patients. J Neurol Sci 160:41–46CrossRefPubMed
22.
go back to reference De Freitas GR, Andrè C (2006) Sensitivity of transcranial Doppler for confirming brain death: a prospective study of 270 cases. Acta Neurol Scand. doi:10.1111/j 1605-04040 De Freitas GR, Andrè C (2006) Sensitivity of transcranial Doppler for confirming brain death: a prospective study of 270 cases. Acta Neurol Scand. doi:10.​1111/​j 1605-04040
23.
go back to reference Hemphill JC III (2006) Policy for determination of death by brain criteria. American Academy of Neurology, California Hemphill JC III (2006) Policy for determination of death by brain criteria. American Academy of Neurology, California
24.
go back to reference Cabrer C, Dominguez-Roldan JM, Manyalich M, Trias E, Paredes D, Navarro A, Nicolàs J, Valero R, Garcìa C, Ruiz A, Vilarrodona A (2003) Persistence of intracranial diastolic flow in transcranial Doppler sonography exploration of patients in brain death. Trans Proceed 35:1642–1643CrossRef Cabrer C, Dominguez-Roldan JM, Manyalich M, Trias E, Paredes D, Navarro A, Nicolàs J, Valero R, Garcìa C, Ruiz A, Vilarrodona A (2003) Persistence of intracranial diastolic flow in transcranial Doppler sonography exploration of patients in brain death. Trans Proceed 35:1642–1643CrossRef
25.
go back to reference Wijdicks EF (2001) The diagnosis of brain death. N Engl J Med 344(16):1215–1221 Wijdicks EF (2001) The diagnosis of brain death. N Engl J Med 344(16):1215–1221
Metadata
Title
The relevance of early TCD monitoring in the intensive care units for the confirming of brain death diagnosis
Authors
Marinella Marinoni
Fabiana Alari
Veronica Mastronardi
Adriano Peris
Paola Innocenti
Publication date
01-02-2011
Publisher
Springer Milan
Published in
Neurological Sciences / Issue 1/2011
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI
https://doi.org/10.1007/s10072-010-0407-1

Other articles of this Issue 1/2011

Neurological Sciences 1/2011 Go to the issue