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Oral Presentation 2 on Brain Death
40.6 - Role of CT angiography in confirmation of brain death
Presenter: Gopal, Taori, Melbourne, Australia Authors: Subhash Arora, Gopal Taori
Role of CT angiography in confirmation of brain death
Subhash Arora1, Gopal Taori1
1Intensive Care, Monash Health, Melbourne, Australia
Confirmation of brain death requires demonstration of intracranial circulatory arrest, especially when clinical assessment is not possible due to presence of confounding factors. The ANZICS guideline accepts conventional 4 vessel cerebral angiography and cerebral perfusion scintigraphy as "gold standard" to make such diagnosis. However these procedures are disadvantaged by invasiveness, limited availability, operator dependence and sometimes substantial delay.
Around the world, various other technical aids are used to confirm the diagnosis of brain death. These include somatosensory evoked potential (SSEP), electroencephalography (EEG) and transcranial doppler ultrasonography (TCD). These often yield discordant results necessitating interpretation by expert examiners.
In recent times, CT angiography (CTA) with CT brain perfusion study, is emerging as a viable alternative and has been licensed for use in some countries. While the results of studies so far, comparing conventional cerebral angiography and CTA with or without CT perfusion favour using the later as a rapid method for confirmation of diagnosis of brain death, larger studies are needed to validate their findings further.
In our presentation, we describe the various technical aids used to determine the diagnosis of brain death, provide information that will be useful in deciding which of the available techniques to use and compare the results of CT angiography available so far with those of other forms of examination. We also discuss the ethical and practical issues around a proposed study comparing CT angiography using a new 320-slice CT scanner and conventional cerebral angiography.
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