The use of cerebral computed tomographic angiography as an ancillary investigation to support a clinical diagnosis of death using neurological criteria: a consensus guideline

Abstract

This multidisciplinary consensus statement was produced following a recommendation by the Faculty of Intensive Care Medicine to develop a UK guideline for ancillary investigation, when one is required, to support the diagnosis of death using neurological criteria. A multidisciplinary panel reviewed the literature and UK practice in the diagnosis of death using neurological criteria and recommended cerebral CT angiography as the ancillary investigation of choice when death cannot be confirmed by clinical criteria alone. Cerebral CT angiography has been shown to have 100% specificity in supporting a diagnosis of death using neurological criteria and is an investigation available in all acute hospitals in the UK. A standardised technique for performing the investigation is described alongside a reporting template. The panel were unable to make recommendations for ancillary testing in children or patients receiving extracorporeal membrane oxygenation.

Ancillary tests to support the diagnosis of death using neurological criteria: certainty in uncertain times?

“…However, there are some unanswered questions regarding the implementation of the guidelines from Thomas et al [8] within UK clinical practice. First is the timing of the cerebral CTA.…”

“…The consensus statement by Thomas et al [8] will be welcomed by the UK intensive care community by providing clear, pragmatic guidance for situations that are often extremely challenging for clinicians. Whilst cerebral CTA is not the gold‐standard investigation, it is a practical first‐line investigation within the UK healthcare setting and one that is likely to be used increasingly because of this consensus statement.…”

“…This variation in practice is mirrored in national recommendations from the UK, Australia and New Zealand, Canada and the USA, in terms of prerequisites for testing, protocols and use of ancillary tests (Table 1). As such, the consensus guideline published in this issue of Anaesthesia that provides clear advice regarding the use of ancillary tests will be welcomed by UK clinicians [8].…”

“…The consensus guideline from Thomas et al has been endorsed by all the relevant UK bodies who are routinely involved in using ancillary tests as part of the diagnosis of death using neurological criteria [8]. The guideline recommends the use of cerebral computed tomographic angiography (CTA) as the standard ancillary investigation for patients in the UK.…”

“…Whilst acknowledging the logistical advantages of cerebral CTA as an ancillary test in the diagnosis of death using neurological criteria, the most important consideration is the accuracy of this investigation. Thomas et al [8] have recognised that it is the specificity of the test that is key when making a diagnosis of death, and cerebral CTA performs well in this regard. Based on 19 studies involving 836 patients, the World Brain Project cites a specificity of 100% for cerebral CTA in the diagnosis of death using neurological criteria [11].…”