title: Doppler Ultrasonography of the Central Retinal Vessels in Children With Brain Death.
abstract: OBJECTIVE
  The purpose of this observational study is to explore if bedside Doppler ultrasonography of the central retinal vessels has the potential to become an ancillary study to support the timely diagnosis of brain death in children.
  
  
  METHODS
  Seventeen-month prospective observational cohort.
  
  
  METHODS
  Forty-four bed pediatric medical and surgical ICU in an academic teaching hospital.
  
  
  METHODS
  All children 0-18 years old who were clinically evaluated for brain death at Children's National Health Systems were enrolled and followed until discharge or death.
  
  
  METHODS
  None.
  
  
  RESULTS
  All patients had at least one ophthalmic ultrasound within 30 minutes of each brain death examination. The central retinal artery peak systolic blood flow velocity, resistive index, pulsatility index, and Doppler waveforms were evaluated in each patient. Thirty-five ophthalmic ultrasounds were obtained on 13 patients, 3 months to 15 years old, who each had two clinical examinations consistent with brain death. The average systolic blood pressure during the ultrasound examinations was 102 mm Hg (± 28), diastolic blood pressure 65 mm Hg (± 24), mean arterial pressure 79 mm Hg (± 23), heart rate 133 beats/min (± 27), temperature 36°C (± 0.96), arterial CO2 35 mm Hg (± 9), and end-tidal CO2 23 mm Hg (± 6). For all examinations, the average peak systolic velocity of the central retinal artery was significantly decreased at 4.66 cm/s (± 3.2). Twelve of 13 patients had both resistive indexes greater than or equal to 1, average pulsatility indexes of 3.6 (± 3.5) with transcranial Doppler waveforms consistent with brain death. Waveform analysis of the 35 ultrasound examinations revealed 11% with tall systolic peaks without diastolic flow, 17% with oscillatory flow, 29% showed short systolic spikes, and 23% had no Doppler movement detected. A rippling "tardus-parvus" waveform was present in 20% of examinations.
  
  
  CONCLUSIONS
  This study supports that the combination of qualitative waveform analysis and quantitative blood flow variables of the central retinal vessels may have the potential to be developed as an ancillary study for supporting the diagnosis of brain death in children.
authors.affiliation: 1Division of Pediatric Anesthesiology and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD. 2Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC. 3Division of Emergency Medicine, Children's National Health System, Washington, DC. 4Division of Ophthalmology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA. 5Division of Cardiac Intensive Care Medicine, Children's National Health System, Washington, DC. 6Division of Pediatric Critical Care, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA. 7Division of Critical Care Medicine, Children's National Health System, Washington, DC.
authors.forename: Becky J
authors.initials: BJ
authors.lastname: Riggs
authors.forename: Joanna S
authors.initials: JS
authors.lastname: Cohen
authors.forename: Bhavana
authors.initials: B
authors.lastname: Shivakumar
authors.forename: Carmelina
authors.initials: C
authors.lastname: Trimboli-Heidler
authors.forename: Jason T
authors.initials: JT
authors.lastname: Patregnani
authors.forename: Marijean M
authors.initials: MM
authors.lastname: Miller
authors.forename: Michael C
authors.initials: MC
authors.lastname: Spaeder
authors.forename: Nathan P
authors.initials: NP
authors.lastname: Dean
mesh_terms: D000293:Adolescent; D001926:Brain Death / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D000067716:Point-of-Care Testing; D011446:Prospective Studies; D012171:Retinal Vessels / Q000000981:diagnostic imaging*; D018608:Ultrasonography, Doppler