Is a Second Transcranial Doppler Study Needed to Confirm Neurocirculatory Arrest?

IF 3.6 3区 医学 Q2 CLINICAL NEUROLOGY
Neurocritical Care Pub Date : 2025-10-01 Epub Date: 2025-03-25 DOI:10.1007/s12028-025-02241-0
Tiffany Eatz, Yosdely Cabrera, Frank Cabrera, Mohan Kottapally, Amedeo Merenda, Ayham Alkhachroum, Jose G Romano, Sebastian Koch
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引用次数: 0

Abstract

Background: In determining brain death, transcranial Doppler (TCD) is one of the recommended ancillary tests when clinical examinations and apnea tests are contraindicated. The American Academy of Neurology 2023 guideline updates and 2020 World Brain Death Project advise conducting two TCDs 30 min apart to diagnose neurocirculatory arrest. Our study aimed to evaluate whether a second TCD is necessary when the first TCD shows neurocirculatory arrest (no flow, oscillating flow, or systolic spikes).

Methods: We conducted a single-center retrospective analysis of patients admitted to intensive care units from January 1, 2021, to February 1, 2025, at a community-based academic hospital. We included patients whose first study showed neurocirculatory arrest and who subsequently underwent a confirmatory TCD at least 30 min apart. A total of 48 patients were included in our final analysis. We compared the findings of the first TCD study with those of the second study and noted any differences.

Results: In all 48 patients (100%), the second TCD confirmed the findings of the first TCD. Of these 48 patients, 44 patients (91.7%) had the same flow pattern on repeat TCD examination and 4 patients' (8.30%) TCDs showed different flow patterns, although still consistent with neurocirculatory arrest. Of the 44 patients with the same flow patterns found on first and repeat TCD examinations, 18 patients (40.9%) had both TCDs demonstrate brief systolic spikes; three patients (6.80%) had both TCDs demonstrate brief systolic spikes and oscillating flow; eight patients (18.2%) had both TCDs demonstrate no flow; seven patients (15.9%) had both TCDs demonstrate no flow and brief systolic spikes; one patient (2.30%) had both TCDs demonstrate no flow, brief systolic spikes, and oscillating flow; and, lastly, seven patients (15.9%) had both TCDs demonstrate oscillating flow.

Conclusions: We found that requiring two sequential TCD examinations to confirm neurocirculatory arrest may be unnecessary when the first TCD shows neurocirculatory arrest. Further investigation and studies such as ours in larger populations are warranted.

确认神经循环骤停需要第二次经颅多普勒检查吗?
背景:在确定脑死亡时,经颅多普勒(TCD)是临床检查和呼吸暂停检查禁忌时推荐的辅助检查之一。美国神经病学学会2023指南更新和2020年世界脑死亡项目建议间隔30分钟进行两次tcd诊断神经循环骤停。我们的研究旨在评估当第一次TCD出现神经循环骤停(无血流、振荡血流或收缩尖峰)时是否有必要进行第二次TCD。方法:我们对某社区学术医院2021年1月1日至2025年2月1日入住重症监护病房的患者进行了单中心回顾性分析。我们纳入了首次研究显示神经循环停止并随后间隔至少30分钟接受确认TCD的患者。我们最终分析了48例患者。我们将第一项TCD研究的结果与第二项研究的结果进行了比较,并注意到任何差异。结果:48例患者(100%)第二次TCD证实了第一次TCD的发现。48例患者中,44例(91.7%)重复TCD检查血流模式相同,4例(8.30%)TCD显示血流模式不同,但仍与神经循环骤停一致。在首次和重复TCD检查中发现相同血流模式的44例患者中,18例(40.9%)两种TCD均表现为短暂的收缩尖峰;3例(6.80%)两种tcd均表现为短暂的收缩尖峰和振荡血流;8例(18.2%)双tcd均无血流;7例(15.9%)双tcd均无血流和短暂的收缩尖峰;1例(2.30%)双tcd均无血流、短暂收缩期尖峰和振荡血流;最后,7例患者(15.9%)双tcd均表现为振荡血流。结论:我们发现,当第一次TCD显示神经循环停止时,需要两次连续TCD检查来确认神经循环停止可能是不必要的。在更大的人群中进行进一步的调查和研究是有必要的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Neurocritical Care
Neurocritical Care 医学-临床神经学
CiteScore
7.40
自引率
8.60%
发文量
221
审稿时长
4-8 weeks
期刊介绍: Neurocritical Care is a peer reviewed scientific publication whose major goal is to disseminate new knowledge on all aspects of acute neurological care. It is directed towards neurosurgeons, neuro-intensivists, neurologists, anesthesiologists, emergency physicians, and critical care nurses treating patients with urgent neurologic disorders. These are conditions that may potentially evolve rapidly and could need immediate medical or surgical intervention. Neurocritical Care provides a comprehensive overview of current developments in intensive care neurology, neurosurgery and neuroanesthesia and includes information about new therapeutic avenues and technological innovations. Neurocritical Care is the official journal of the Neurocritical Care Society.
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