Premium
Xenon computed tomography measuring cerebral blood flow in the determination of brain death in children
Author(s) -
Ashwal Stephen,
Schneider Sanford,
Thompson Joseph
Publication year - 1989
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.410250603
Subject(s) - cerebral blood flow , medicine , anesthesia , population , blood flow , computed tomography , nuclear medicine , cardiology , surgery , environmental health
Abstract Local cerebral blood flow was measured using stable xenon computed tomography in 21 children, 10 of whom were clinically brain dead and had electrocerebral silence as determined by electroencephalography. Radioisotopic brain scanning in 9 patients showed no visible cerebral activity in all patients and minimal residual sagittal sinus activity in 4. In this population, mean cerebral blood flow as measured by xenon computed tomography was 1.3 ± 1.6 ml/min/100 gm. Respiratory support was discontinued in 8 patients, and 2 patients had cardiac arrest. Eleven profoundly comatose children who did not meet all clinical criteria for brain death and who had markedly suppressed but not isoelectric electroencephalograms had an average cerebral blood flow of 33.5 ± 16.3 ml/min/100 gm as determined by xenon computed tomography. Flows in this group ranged from 11.8 ± 4.1 to 62.3 ± 1.9 ml/min/100 gm. There was no difference in cerebral blood flow in those children who survived (30.4 ± 16.3 ml/min/100 gm; n = 7) compared with those who died acutely (38.3 ± 14.3 ml/min/100 gm; n = 4). Two patients who survived had average total flows of only 11.8 and 12.1 ml/min/100 gm. Our findings suggest that in infants and children older than 1 month, (1) cerebral blood flow below approximately 10 ml/min/100 gm is consistent with clinical brain death, (2) cerebral blood flow of less than 5 ml/min/100 gm is consistent with no flow as demonstrated by radionuclide techniques, and (3) flow of more than 10 to 15 ml/min/100 gm is associated with the potential for survival.