![]() ![]() 12 Knowing its advantages and limitations can help resolve frequent diagnostic problems in the intensive care unit (ICU), avoid unnecessary resource consumption, and optimize the obtainment of organs for transplantation. Transcranial Doppler ultrasound is one of the most widely used methods for diagnosing BD, and is legally accepted in Spain. In Spain, almost 90% of all transplants are performed with organs obtained from donors that have died under conditions of BD. 5–11 The diagnosis of BD is a key element in all national transplant programs. 3,4 If the patient is sedated, suffers serious craniofacial damage, or presents intolerance of the apnea test, techniques that study brain circulatory flow, such as angiography with multislice computed tomography (CT), brain scintigraphy with Tc 99-HMPAO, or transcranial Doppler (TCD) are advised. 1,2 Instrumental tests may be obligate in some clinical cases, and vary according to the legal specifications in force in each individual country. The diagnosis of BD is based on an exhaustive neurological exploration that must abide with certain international standards. ![]() Cerebral circulatory arrest (CCA) that accompanies BD occurs when the intracranial pressure (ICP) exceeds the systolic blood pressure of the patient. Its diagnosis has great medical, ethical and legal implications, since it represents certification of the death of the patient and therefore allows withdrawal of all the artificial support measures, or organ harvesting for transplantation purposes. Su rentabilidad diagnóstica es, por tanto, dependiente del tiempo, hecho que debe ser reconocido para no retrasar la declaración de muerte.Ī pesar de sus limitaciones, el Doppler transcraneal ayuda a resolver frecuentes problemas diagnósticos, evita un consumo innecesario de recursos y puede optimizar la obtención de órganos para trasplante.īrain death (BD) is defined as irreversible cessation of the brain and brainstem functions. En pacientes con diagnóstico clínico de muerte encefálica, que tienen cráneos abiertos o anoxia como causa de la muerte, puede sonorizarse flujo sanguíneo cerebral, ya que la parada circulatoria cerebral no siempre es sincrónica con el diagnóstico clínico. Entre sus limitaciones está la ausencia de ventana sónica y los casos falsos negativos. El Doppler transcraneal permite demostrar la parada circulatoria cerebral que acompaña a la muerte encefálica, siendo especialmente útil en pacientes sedados, o en los que no puede realizarse la exploración neurológica completa.Įl Doppler transcraneal es una técnica portátil, no invasiva y de alta disponibilidad. ![]()
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