Introduction: Conventional cerebral angiography has long been considered the gold standard as a confirmatory test in assessing intracranial blood flow in brain death determination. Computerized tomographic angiography (CTA) is a non-invasive test that can provide the same information with certain advantages, however, there is no consensus pertaining to the technical protocol or interpretation of CTA in this context. We aimed to compare CTA with invasive angiography in determining intracranial blood flow as a confirmatory test in brain death determination.
Methods: We prospectively enrolled 22 patients with brain death determined by neurologic examination and apnea testing to receive confirmatory testing by both CTA and conventional angiography. Sixteen patients received both CTA and conventional angiography as a confirmatory test. Six patients (27%) did not receive both tests due to either cardiac arrest before both tests could be performed or hemodynamic instability precluding patient transportation. Radiographic data was evaluated by a neuroradiologist.
Results: Fourteen patients (87.5%) had conventional angiograms that showed complete lack of intracranial blood flow consistent with brain death. All fourteen of these patients (100%) had CTA studies that were consistent with brain death. The two patients with persistent intracranial flow on conventional angiography also had distal arterial and deep venous flow on CTA.
Conclusions: In this prospective study, CTA was equivalent to conventional angiography as a confirmatory test in brain death determination. Clinical examination and apnea testing remain the gold standard but when confirmatory testing is necessary, our data suggests that CTA is equivalent to angiography and should be considered as a reliable and efficient alternative to other accepted forms of confirmatory testing.
Patient Care: Confirmatory testing in brain death determination can be done less invasively and more quickly with CT angiography compared to conventional invasive angiography
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of confirmatory testing in brain death determination 2)Identify that CT angiography is equivalent to cerebral angiography in evaluating intracranial blood flow in the context of brain death determination