title: The value of transcranial Doppler sonography with a transorbital approach in the confirmation of cerebral circulatory arrest.
abstract: OBJECTIVE
  Transcranial Doppler sonography (TCD) provides accurate confirmation of cerebral circulatory arrest (CCA) in brain death (BD), but is not feasible in patients with absent temporal bone windows. We added the transorbital approach in the TCD protocol for the diagnosis of CCA and compared findings with angiography. Furthermore, we evaluated whether reporting the angiographic and sonographic confirmation of CCA to relatives of brain-dead patients improves their comprehension and satisfaction with the medical information.
  
  
  METHODS
  Eighty-two clinically brain-dead patients underwent 4-vessel angiography, TCD of the basilar and middle cerebral arteries, and transorbital Doppler sonography (TOD) of the internal carotid arteries. Relatives were randomly allocated to 41 in whom BD was presented as a clinical diagnosis (group A) and to 41 in whom BD was presented as a clinical diagnosis confirmed by TCD and angiography (group B). Comprehension and satisfaction of the relatives were assessed using an interview and a questionnaire.
  
  
  RESULTS
  Both angiography and TCD verified CCA in all cases (k = 1). In 11 patients with failure of the transtemporal approach, CCA was confirmed by the transorbital recordings. The addition of TOD enabled 15.5% more cases of CCA to be diagnosed by TCD. Group B exhibited improved comprehension and satisfaction rates (P < .05).
  
  
  CONCLUSIONS
  The addition of TOD increases the efficacy of TCD in confirming CCA in BD. Reporting confirmation of CCA to families of brain-dead patients may improve their comprehension and satisfaction with the provided medical information.
authors.affiliation: Department of Radiology and Imaging G. Gennimatas General State Hospital, Athens, Greece.
authors.forename: T
authors.initials: T
authors.lastname: Soldatos
authors.forename: D
authors.initials: D
authors.lastname: Karakitsos
authors.forename: M
authors.initials: M
authors.lastname: Wachtel
authors.forename: J
authors.initials: J
authors.lastname: Boletis
authors.forename: K
authors.initials: K
authors.lastname: Chatzimichail
authors.forename: M
authors.initials: M
authors.lastname: Papathanasiou
authors.forename: A
authors.initials: A
authors.lastname: Gouliamos
authors.forename: A
authors.initials: A
authors.lastname: Karabinis
mesh_terms: D001794:Blood Pressure; D001926:Brain Death / Q000000981:diagnostic imaging*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D002560:Cerebrovascular Circulation; D005190:Family; D006323:Heart Arrest / Q000000981:diagnostic imaging*; D006339:Heart Rate; D006801:Humans; D007362:Intensive Care Units; D014019:Tissue Donors; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*