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Ancillary tests used for Brain Death Diagnosis in Buenos Aires City

Ancillary tests used for Brain Death Diagnosis in Buenos Aires City. Previgliano I, Fioretti S, Lara J, Balbuena V, Baqué MC Buenos Aires Trasplant Institute – GCBA Neurocritical Care and Organ and Tissue Procurement for Trasplantation Management Unit – Hospital J. A. Fernández. Background.

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Ancillary tests used for Brain Death Diagnosis in Buenos Aires City

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  1. Ancillary tests used for Brain Death Diagnosis in Buenos Aires City Previgliano I, Fioretti S, Lara J, Balbuena V, Baqué MC Buenos Aires Trasplant Institute – GCBA Neurocritical Care and Organ and Tissue Procurement for Trasplantation Management Unit – Hospital J. A. Fernández

  2. 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).

  3. 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

  4. 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.

  5. 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%)

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

  7. 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

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

  9. 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

  10. 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

  11. Questions? Questions? Instituto de Trasplante de Buenos Aires

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