Portable gamma-camera for the diagnosis of brain death diagnosis

Abstract

ObjectiveTo evaluate the feasibility of using the Sentinella® portable gamma-camera for the diagnosis of brain death (BD). DesignA prospective, observational feasibility study was carried out. SettingIntensive Care Unit of a third level hospital. PatientsConsecutive recording was made of the adults diagnosed with brain death based on clinical criteria following admission to the Intensive Care Unit in the period from January to December 2017. InterventionsThe procedure was performed at the patient bedside with the intravenous administration of technetium 99 metastable hexamethylpropylene amine oxime. The absence of perfusion in the cerebral hemispheres and brainstem was described as a pattern consistent with BD. The diagnosis was correlated to the transcranial Doppler and/or electroencephalographic findings. ResultsA total of 66.1% of the patients were men with an average age of 60 years [IQR: 51–72]. The most frequent causes resulting in BD were hemorrhagic stroke (48.2%, n=27), followed by traumatic brain injury (30.4%, n=17), ischemic stroke (10.7%, n=6) and post-cardiac arrest anoxic encephalopathy (7.1%, n=4). A clinical diagnosis of BD was made in all cases, and the portable gamma-camera confirmed the diagnosis in 100% of the patients with a pattern characterized by the absence of brain perfusion. In addition, the results were compared with the transcranial Doppler findings in 46 patients, confirming the presence of diastolic reverberation and/or systolic peaks. The electroencephalographic tracing was obtained in 10 cases, with the appearance of electrical silence, due to the absence of an acoustic window in the transcranial Doppler study. ConclusionsA portable gamma-camera could be a useful and feasible tool for the diagnosis of BD.