Benefits of combination of electroencephalography, short latency somatosensory evoked potentials, and transcranial Doppler techniques for confirming brain death

Abstract

Abstract:Objective: Optimization of combining electroencephalography (EEG), short latency somatosensory evoked potentials (SLSEP) and transcranial Doppler (TCD) techniques to diagnose brain death. Methods: One hundred and eleven patients (69 males, 42 females) from the major hospitals of Zhejiang Province were examined with portable EEG, SLSEP and TCD devices. Re-examinations occurred ≤12 h later. Results: The first examination revealed that the combination of SLSEP and EEG led to more sensitive diagnoses than the combination of SLSEP and TCD. Re-examination confirmed this and also revealed that the combination of TCD and EEG was the most sensitive. Conclusion: The results show that using multiple techniques to diagnose brain death is superior to using single method, and that the combination of SLSEP and EEG is better than other combinations.

Diagnostic Accuracy of Transcranial Doppler for Brain Death Confirmation: Systematic Review and Meta-Analysis

“…41 Unclear bias was introduced in applicability concerns/patient selection in 6 studies because pediatric patients were included in the analysis. 33,34,37,42,45,47 Finally, high bias was introduced in 1 study in applicability concerns/index test because in addition to the standard TCD transtemporal window, contrast-induced TCD was used. 26 No study had Ͼ2 high risks of bias noted.…”

“…unfortunate, as evidenced by mean ages, these populations were primarily adult. 33,34,37,42,45,47 Finally, 1 study introduced high bias in applicability concerns/index test because while using tests that incorporated a standard TCD window (transtemporal), this study also introduced contrast-induced TCD to increase sensitivity. 26 …”

Variability Across Countries for Brain Death Determination in Adults

“…Somatosensory evoked potentials (SEPs) examines lemniscal pathways in the hemispheres and brainstem, and was reported to be a reliable test for brain death determination with a sensitivity of 87.4%-100% [18][19][20] . The examination of cerebral circulation provides an alternative evaluation of brain function.…”

The role of neurophysiological methods in the confirmation of brain death

“…So, it can provide useful information about clinical findings of the function of the brain stem and cerebral cortex and in adverse conditions without changing its parameters (latency, amplitude and morphology of the wave), which is not the case with the EEG 17,18 . These tests are safe, accurate and they significantly improve and accelerate the procedure of taking the cadaver 11,12,[19][20][21][22][23] . The significance of evoked potentials in the diagnosis of brain death is presented in the research done by Facco et al 24 2002.…”