![]() Most recently, a meta-analysis of 10 studies demonstrated TCD having a sensitivity of 89% and specificity of 99% compared with the criterion standard clinical confirmation of brain death. TCD confirms brain death by evaluating cerebral circulatory arrest (CCA), which has distinctive flow patterns: oscillatory flow representing reversal of diastolic flow and systolic spikes representing lack of net forward flow.Ĭase reports and case series have generally reported good correlations between TCD confirmation of CCA and clinical confirmation of brain death, with sensitivities ranging from 70.5% to 100%. Transcranial Doppler (TCD) is useful for ancillary brain death confirmation because it is safe and noninvasive. 7 In such circumstances, ancillary testing may complement criterion standard testing and confirm brain death. 3, 4 However, ancillary tests remain essential in brain death confirmation when clinical instability prevents safe use of an apnea test 5, 6 or barbiturate therapy or hypothermia precludes proper brain death confirmation. The latest guidelines from the American Academy of Neurology and American Academy of Pediatrics report insufficient evidence for determining brain death with ancillary tests. ![]() ![]() 2Īncillary testing for brain death confirmation remains controversial. 1 Today, the clinical examination, apnea test, etiology, and ascertainment of irreversibility radiologic confirmation of a structural lesion and elimination of confounding laboratory tests remain the criterion standard for brain death diagnosis. The concept and irreversibility of brain death have evolved in the past 50 years, further differentiating it from “irreversible coma” as initially described in 1968. ABBREVIATIONS: CCA cerebral circulatory arrest Q* index Q test QUADAS Quality Assessment of Diagnostic Accuracy Studies sROC summary receiver operating curve TCD transcranial Doppler SE standard error
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