Practice of transcranial Doppler-assisted brain death determination

Abstract: OBJECTIVE: The objective of this study was to explore the selection of confirmation test techniques when there are flaws in the clinical brain death determination (BDD). METHODS: Three comparison analyses were conducted using three confirmation tests according to the Chinese criteria for BDD. First, based on the clinical results of brain death (BD), patients were divided into a BD group and a non-BD group. Second, according to the clinical results of BD, patients were divided into a BD group without flaws (BD1 group) and with flaws (BD2 group). Third, the BD1 group and BD2 group were divided according to different brain injury sites. RESULTS: The first comparison revealed that the area under the receiver operating characteristic curve (AUC) of transcranial Doppler (TCD) combined with electroencephalography (EEG)/short-latency somatosensory evoked potential (SLSEP) was 0.997/0.995, with a false-positive rate of 0, which was better than independent TCD. The second comparison revealed that the AUC of TCD combined with EEG/SLSEP in the BD1 and BD2 groups increased to 0.990–1.000, with a false-positive rate reduced to 0, which was better than independent TCD. The third comparison revealed that for different brain injury sites in the BD1 group, the AUC of TCD combined with EEG/SLSEP was 1.000, with a false-positive rate of 0, which was better than independent TCD. For different brain injury sites in the BD2 group, the AUC of TCD combined with EEG/SLSEP was 0.985–1.000, with a false-positive rate of 0, which was better than that of independent TCD. CONCLUSION: If there are flaws in clinical BDD, the use of TCD combined with EEG/SLSEP can improve the accuracy of BDD.