DECOMPRESSIVE CRANIECTOMY AND BRAIN DEATH Prevalence and Mortality. Eight-Year Retrospective Review. Pereyra, C. Benito Mori, L. Violi, D. Jacintho, P. Segui, G. Losio, D. Lugaro, M. Diaz, G. Strati, J. Prieto, M. Benavent, G. Schoon, P. H.I.G.A Prof. Dr Luis Güemes Buenos Aires, Argentina H.I.G.A Prof. Dr Luis Güemes Buenos Aires, Argentina
INTRODUCTION • Decompressivecraniectomy (DC) is a surgical practice that has been used since the late nineteenth century and that has recently reappeared in daily practice. • The main objective of this technique is to avoid the mass effect that leads to transtentorial herniation, brainstem destruction, cardiorespiratory instability and, eventually, to neurological death • OBJECTIVES • 1. To assess the prevalence of death based on neurological criteria (DBNC) and the performance of DC in an 8-year period. • 2. To compare mortality associated with DC and evolution to DBNC.
MATERIALS & METHODS A retrospective, observational, cross-sectional study (January 2003-December 2010) Inclusion criteria: All patients with a Glasgow coma score of ≤ 7 on admission or during their stay in the intensive care unit. Exclusion criteria: Patients without data of the outcome at discharge.
MATERIALS & METHODS The data recorded was: sex, age, diagnosis at admission, performance of DC and condition at discharge (discharge or death). In case of death, the fulfillment of DBNC criteria was assessed according to the Argentine National Law 24.193. Chi square was used for statistical analysis, with a value of significance of < 0.05.
RESULTS Excluded 13 patients CATEGORIES Trauma 335 pts (48%) SAH 122 pts (17%) ICH 125 pts (18%) Ischemic stroke 35 pts (5%) Medical 81 pts (12%)
RESULTS Annual Prevalence Rate for DC 30 % Chi squarefor linear trend 4.07 p value 0,043
RESULTS Annual Prevalence Rate for DBCN Chi squarefor linear trend0.001 p value0,97
RESULTS Mortality p <0.001, RR 0.73, IC95 0.62-0.86 Causes of death Cardiac arrest 270 pts (65%) - DBNC 108 pts (26%) Excluded 40 pts (9%) not assessed completely for the diagnosis of DBNC
RESULTS Evolution to DBNC 24 pts (28%) DBNC No significant differences between groups 84 pts (29%) DBNC
CONCLUSIONS High prevalence of DC and better survival were recorded in comparison with the group in which this procedure was not performed. The prevalence of DBNC was lower than expected in accordance with national registries; however, in this analyzed group, DC did not modify the evolution to DBNC Thankyouforyourattention