A pilot study of transcranial Doppler-guided initial resuscitation of traumatic and non-traumatic comatose patients.
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.


CONCLUSIONS
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.
Instituto Argentino de Diagnóstico y Tratamiento, Buenos Aires, Argentina - iprevi@intramed.net.
F
F
Tamagnone
E
E
Martínez
S D
SD
Blejman
J I
JI
Rubianes
I J
IJ
Previgliano
D000328:Adult; D000368:Aged; D001926:Brain Death / Q000000981:diagnostic imaging; D002560:Cerebrovascular Circulation; D003128:Coma / Q000000981:diagnostic imaging* / Q000628:therapy*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods*; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*; D014947:Wounds and Injuries / Q000000981:diagnostic imaging* / Q000628:therapy*; D055815:Young Adult