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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2014 September;80(9):1012-7
A pilot study of transcranial Doppler-guided initial resuscitation of traumatic and non-traumatic comatose patients
Tamagnone F. 1, Martínez E. 2, 3, Blejman S. D. 3, Rubianes J. I. 1, Previgliano I. J. 2 ✉
1 Instituto Argentino de Diagnóstico y Tratamiento, Buenos Aires, Argentina;
2 Hospital General de Agudos Juan A. Fernández, Buenos Aires, Argentina;
3 Sanatorio Colegiales, Buenos Aires, Argentina
BACKGROUND: The aim of this study was to evaluate the usefulness of early Transcranial Doppler (TCD) in guiding initial resuscitation of traumatic and non-traumatic comatose patients before diagnostic imaging and invasive neurologic monitoring.
METHODS: This was a prospective, interventional study and included patients in coma, before performing diagnostic imaging. A TCD was performed as soon as possible upon admission. Diastolic velocity (DV) <20 cm/s and Pulsatility Index (PI) >1.4 at both middle cerebral arteries were considered abnormal and specific therapy was started with fluid expansion with 2 L 0.9% saline solution, followed by norepinephrine infusion to increase MAP above 110 mmHg. An increment in DV >20 cm/s was considered as a good response.
RESULTS: Twenty-eight patients were included, 9 had normal TCD and 19 (68%) had abnormal TCD values. Mean values pre- and post-treatment were: MAP 84±16/121±9 mmHg; PI 2.26±0.52/1.28±0.47; DV 13±7/33±18 cm/s (P<0.0001 for all values); 13 patients (68%) were responders. Global mortality was 46 %. We find that the presence of oscillating flow, systolic peak or DV <20 cm/s after treatment, were associated with brain death in 100% of cases. Presence of a normal TCD was associated with no mortality.
CONCLUSION: Our study suggests that early TCD is feasible to evaluate qualitative information about cerebral perfusion in comatose patients while they are waiting for diagnostic imaging studies.