Status of Brain Death Diagnosis in Brazil: The Role of Transcranial Doppler Ultrasonography

Abstract

Transcranial Doppler Ultrasonography (TCDU) comprises an indispensable tool for brain death (BD) protocol closure due to its practicality and low cost. In Brazil, it is used in most organ procurement organization (OPO) centers for this purpose. The evaluation of its importance in the diagnosis of BD in Brazil nowadays constitutes the main scope of this work. Objectives: analysis of the results of TCDU from a series of 100 consecutive patients with clinical diagnosis of BD, with calculation of sensitivity and time intervals for closure of protocols. Evaluation of the variables gender, age, diseases causing death and presence of decompressive cranial surgery in relation to time to death. Methods: evaluation of CT scans, TCDU and medical records of patients on BD protocol with statistical analysis of the sample. Results: 145 TCDU examinations in 100 patients (62% male) were evaluated. Systolic spicules were found in 40.1%, reduced flow velocity in 12.9%, diastolic reversal in 8.3%, no flow in 5.2% and normal flow in 3.5%. Sensitivity ranged from 69% to 90.5% when repeated serially. The mean time to complete the protocols was 35.4 hours (SD=±48.2h), with the majority (59.5%) within 24 hours. There was no statistically significant correlation between gender, age or diagnostic variables, presence of decompressive craniectomy and time to death. Conclusion: most TCDU confirmed the status of BD, but a small percentage (9.5%) did not complete the diagnosis, delaying the protocol in these cases.