Transcranial Doppler in the diagnosis of cerebral circulatory arrest: cases of the National Institute of Donation and Transplantation of Uruguay

Abstract

Background: Transcranial Doppler (TCD) is an auxiliary method for the diagnosis of cerebral circulatory arrest (CCA). The objective of this work was to appreciate the efficiency of the method in the diagnosis of the CCA and its outcome in situations such as decompressive craniectomy (DC).

Methods: In this descriptive, retrospective study, conducted between 2000 and 2012, variables considered were causes of brain death (BD), age, sex, application reason, CCA patterns, and CCA patterns in DC. As a statistical approach, Pearson χ(2) distribution was used. A total of 522 cases were analyzed; mean patient age was 30 ± 19 years, and 61% were men.

Results: The principal causes of BD were traumatic brain injury, 44%; subarachnoid hemorrhage, 20%; and post-cardiac arrest anoxic ischemic injury, 17%. TCD was requested by contraindication to apnea testing in 84% of cases, and it diagnosed CCA in 79%. The most frequent pattern of CCA was the systolic spike (70%). CCA was diagnosed in patients with DC in 43% (23/54) compared with 79% (369/468) in those patients without this procedure (P = .0001), with the systolic spike being the most frequent pattern (48%).

Conclusions: TCD is a useful and highly specific tool for the diagnosis of CCA that occurs with BD, diminishing its performance significantly in patients with DC.