Ancillary tests used for Brain Death Diagnosis in Buenos Aires City

Previgliano I, Fioretti S, Lara J, Balbuena V, Baqué MCBuenos Aires Trasplant Institute – GCBA Neurocritical Care and Organ and Tissue Procurement for Trasplantation Management Unit – Hospital J. A. Fernández

Background

Argentinean Organ Donation Law establishes several methods for brain death diagnosis

The protocol includes clinical examination, apnea test (AT) and one or more ancillary tests:

– Electroencephalography (EEG)– Multimodality evoked potentials (somatosensory (EPSS),

auditory (EPA), visual (EPV))– Transcranial doppler (TCD)– Cerebral angiography (CA)– Radioisotopic angiography (RA)– Multislice computed tomography angiography with cerebral

perfusion (CTA).

Aim

The aim of the study is to evaluate the ratio of use of each ancillary test in Brain Death Diagnosis by the procuration team

Material and method

Study design: Prospective collected database analysis.

Inclusion criteria: Patients with brain death diagnosis from 01/01/10 to 31/12/10.

Data collected: AT, EEG, DTC, EPSS, EPA, EPV, TCD, CA, RA, CTA, presence of depressor drugs and decompress craniectomy.

Results

80 patients were brain death diagnosed Neither of them was submitted to Cerebral

Angiography, Radiosotopic Angiography or Computed Tomography Angiography

Apnea test was performed in 61 patients (76%)

Results

EEG in 72 (90%) TCD in 17 (21%) EPA in 11 (14%) EPSS in 5 (6%) EPV in 1 (1%)

0%10%20%30%40%50%60%70%80%90%

EEG TCD EPA EPSS EVP ApneaTest

Results

12 patients receiving depressor drugs were diagnosed by means of:– TCD 10 (83%), only 4 (33%) as single method– EEG 8 (67%), always associated to another

method – EPA 4 (33%), always associated to another

method– EPSS 1 (1%), associated to EEG

Results

Six patients submitted to decompress craniectomy were diagnosed by means of:– AT (100%)– EEG (83%)– TCD (40%).

Results

In 16 patients in which apnea test could not be performed, diagnosis was made by means of:– TCD in 10 (62%)– EP in 6 (38%)– EEG was associated to TCD in 5 patients and to

EP in 6

Conclusions

Our research demonstrates that neurologists are more confident to traditional brain death approach (AT plus EEG) than to modern tools

Combination of AT and EEG was the preferred combination in 63% of cases

DTC was the preferred ancillary test when apnea test couldn’t be performed

EP’s were never used alone as diagnostic criteria CA, RA and CTA weren’t used as ancillary tests

Questions?Questions?

Instituto de Trasplante de Buenos Aires