Subscribe to RSS
DOI: 10.1055/s-0037-1604015
Ancillary Studies in Evaluating Pediatric Brain Death
Publication History
02 May 2017
28 May 2017
Publication Date:
29 June 2017 (online)
Abstract
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.
-
References
- 1 Nakagawa TA, Ashwal S, Mathur M. , et al; Society of Critical Care Medicine; Section on Critical Care and Section on Neurology of the American Academy of Pediatrics; Child Neurology Society. Guidelines for the determination of brain death in infants and children: an update of the 1987 Task Force recommendations. Crit Care Med 2011; 39 (09) 2139-2155
- 2 Wijdicks EF. Brain death worldwide: accepted fact but no global consensus in diagnostic criteria. Neurology 2002; 58 (01) 20-25
- 3 Young GB, Shemie SD, Doig CJ, Teitelbaum J. Brief review: the role of ancillary tests in the neurological determination of death. Can J Anaesth 2006; 53 (06) 620-627
- 4 A definition of irreversible coma. Report of the ad hoc committee of the Harvard Medical School to examine the definition of brain death. JAMA 1968; 205 (06) 337-340
- 5 Wijdicks EF. The case against confirmatory tests for determining brain death in adults. Neurology 2010; 75 (01) 77-83
- 6 Ruiz-García M, Gonzalez-Astiazarán A, Collado-Corona MA, Rueda-Franco F, Sosa-de-Martínez C. Brain death in children: clinical, neurophysiological and radioisotopic angiography findings in 125 patients. Childs Nerv Syst 2000; 16 (01) 40-45
- 7 Ashwal S, Schneider S. Brain death in the newborn. Pediatrics 1989; 84 (03) 429-437
- 8 Holzman BH, Curless RG, Sfakianakis GN, Ajmone-Marsan C, Montes JE. Radionuclide cerebral perfusion scintigraphy in determination of brain death in children. Neurology 1983; 33 (08) 1027-1031
- 9 Bradac GB, Simon RS. Angiography in brain death. Neuroradiology 1974; 7 (01) 25-28
- 10 Ameratunga B, Jefferson NR, Rajapakse S. Further aspects of angiographic brain death. Australas Radiol 1976; 20 (03) 291-295
- 11 Flowers Jr WM, Patel BR. Radionuclide angiography as a confirmatory test for brain death: a review of 229 studies in 219 patients. South Med J 1997; 90 (11) 1091-1096
- 12 Goodman JM, Mishkin FS, Dyken M. Determination of brain death by isotope angiography. JAMA 1969; 209 (12) 1869-1872
- 13 Goodman JM, Heck LL, Moore BD. Confirmation of brain death with portable isotope angiography: a review of 204 consecutive cases. Neurosurgery 1985; 16 (04) 492-497
- 14 Coker SB, Dillehay GL. Radionuclide cerebral imaging for confirmation of brain death in children: the significance of dural sinus activity. Pediatr Neurol 1986; 2 (01) 43-46
- 15 Shimizu N, Shemie S, Miyasaka E. , et al. [Preliminary report: use of clinical criteria for the determination of pediatric brain death and confirmation by radionuclide cerebral blood flow]. Masui 2000; 49 (10) 1126-1132
- 16 Heran MK, Heran NS, Shemie SD. A review of ancillary tests in evaluating brain death. Can J Neurol Sci 2008; 35 (04) 409-419
- 17 Blend MJ, Pavel DG, Hughes JR, Tan WS, Lansky LL, Toffol GJ. Normal cerebral radionuclide angiogram in a child with electrocerebral silence. Neuropediatrics 1986; 17 (03) 168-170
- 18 Kramer AH, Roberts DJ. Computed tomography angiography in the diagnosis of brain death: a systematic review and meta-analysis. Neurocrit Care 2014; 21 (03) 539-550
- 19 Karantanas AH, Hadjigeorgiou GM, Paterakis K, Sfiras D, Komnos A. Contribution of MRI and MR angiography in early diagnosis of brain death. Eur Radiol 2002; 12 (11) 2710-2716
- 20 Kumada K, Fukuda A, Yamane K. , et al. [Diffusion-weighted imaging of brain death: study of apparent diffusion coefficient]. No To Shinkei 2001; 53 (11) 1027-1031
- 21 Nakahara M, Ericson K, Bellander BM. Diffusion-weighted MR and apparent diffusion coefficient in the evaluation of severe brain injury. Acta Radiol 2001; 42 (04) 365-369
- 22 Monsein LH. The imaging of brain death. Anaesth Intensive Care 1995; 23 (01) 44-50
- 23 Aichner F, Felber S, Birbamer G, Luz G, Judmaier W, Schmutzhard E. Magnetic resonance: a noninvasive approach to metabolism, circulation, and morphology in human brain death. Ann Neurol 1992; 32 (04) 507-511
- 24 Jardim M, Person OC, Rapoport PB. [Brainstem auditory evoked potentials as a method to assist the diagnosis of brain death]. Pro Fono 2008; 20 (02) 123-128
- 25 Ruiz-López MJ, Martínez de Azagra A, Serrano A, Casado-Flores J. Brain death and evoked potentials in pediatric patients. Crit Care Med 1999; 27 (02) 412-416
- 26 Wada S. [Brainstem auditory evoked potential]. Nihon Rinsho 1997; 55 (Suppl. 01) 368-370
- 27 Fatouros PP, Wist AO, Kishore PR. , et al. Xenon/computed tomography cerebral blood flow measurements. Methods and accuracy. Invest Radiol 1987; 22 (09) 705-712
- 28 Pistoia F, Johnson DW, Darby JM, Horton JA, Applegate LJ, Yonas H. The role of xenon CT measurements of cerebral blood flow in the clinical determination of brain death. Am J Neuroradiol 1991; 12 (01) 97-103
- 29 Okuyaz C, Gücüyener K, Karabacak NI, Aydin K, Serdaroğlu A, Cingi E. Tc-99m-HMPAO SPECT in the diagnosis of brain death in children. Pediatr Int 2004; 46 (06) 711-714
- 30 Ashwal S. Brain death in the newborn. Current perspectives. Clin Perinatol 1997; 24 (04) 859-882
- 31 Segura T, Calleja S, Irimia P, Tembl JI. ; Spanish Society of Neurosonology. Recommendations for the use of transcranial Doppler ultrasonography to determine the existence of cerebral circulatory arrest as diagnostic support for brain death. Rev Neurosci 2009; 20 (3-4): 251-259
- 32 Mata-Zubillaga D, Oulego-Erroz I. Persistent cerebral blood flow by transcranial Doppler ultrasonography in an asphyxiated newborn meeting brain death diagnosis: case report and review of the literature. J Perinatol 2012; 32 (06) 473-475
- 33 Consensus Group on Transcranial Doppler in Diagnosis of Brain Death. Latin American consensus on the use of transcranial Doppler in the diagnosis of brain death. Rev Bras Ter Intensiva 2014; 26 (03) 240-252
- 34 Monteiro LM, Bollen CW, van Huffelen AC, Ackerstaff RG, Jansen NJ, van Vught AJ. Transcranial Doppler ultrasonography to confirm brain death: a meta-analysis. Intensive Care Med 2006; 32 (12) 1937-1944
- 35 Escudero D, Otero J, Quindós B, Viña L. Transcranial Doppler ultrasound in the diagnosis of brain death. Is it useful or does it delay the diagnosis?. Med Intensiva 2015; 39 (04) 244-250
- 36 Chiu NC, Shen EY, Lee BS. Reversal of diastolic cerebral blood flow in infants without brain death. Pediatr Neurol 1994; 11 (04) 337-340
- 37 Hüttemann E, Schelenz C, Sakka SG, Reinhart K. Atropine test and circulatory arrest in the fossa posterior assessed by transcranial Doppler. Intensive Care Med 2000; 26 (04) 422-425