BACKGROUND: Investigation of the feasibility and usefulness of pre-hospital transcranial Doppler (TCD) to guide early goal-directed therapy following severe traumatic brain injury (TBI). METHODS: Prospective, observational study of 18 severe TBI patients during pre-hospital medical care. TCD was performed to estimate cerebral perfusion in the field and upon arrival at the Level 1 trauma centre. Specific therapy (mannitol, noradrenaline) aimed at improving cerebral perfusion was initiated if the initial TCD was abnormal (defined by a pulsatility index >1.4 and low diastolic velocity). RESULTS: Nine patients had a normal initial TCD and nine an abnormal one, without a significant difference between groups in terms of the Glasgow Coma Scale or the mean arterial pressure. Among patients with an abnormal TCD, four presented with an initial areactive bilateral mydriasis. Therapy normalized TCD in five patients, with reversal of the initial mydriasis in two cases. Among these five patients for whom TCD was corrected, only two died within the first 48 h. All four patients for whom the TCD could not be corrected during transport died within 48 h. Only patients with an initial abnormal TCD required emergent neurosurgery (3/9). Mortality at 48 h was significantly higher for patients with an initial abnormal TCD. CONCLUSIONS: Our preliminary study suggests that TCD could be used in pre-hospital care to detect patients whose cerebral perfusion may be impaired.
BACKGROUND: Investigation of the feasibility and usefulness of pre-hospital transcranial Doppler (TCD) to guide early goal-directed therapy following severe traumatic brain injury (TBI). METHODS: Prospective, observational study of 18 severe TBIpatients during pre-hospital medical care. TCD was performed to estimate cerebral perfusion in the field and upon arrival at the Level 1 trauma centre. Specific therapy (mannitol, noradrenaline) aimed at improving cerebral perfusion was initiated if the initial TCD was abnormal (defined by a pulsatility index >1.4 and low diastolic velocity). RESULTS: Nine patients had a normal initial TCD and nine an abnormal one, without a significant difference between groups in terms of the Glasgow Coma Scale or the mean arterial pressure. Among patients with an abnormal TCD, four presented with an initial areactive bilateral mydriasis. Therapy normalized TCD in five patients, with reversal of the initial mydriasis in two cases. Among these five patients for whom TCD was corrected, only two died within the first 48 h. All four patients for whom the TCD could not be corrected during transport died within 48 h. Only patients with an initial abnormal TCD required emergent neurosurgery (3/9). Mortality at 48 h was significantly higher for patients with an initial abnormal TCD. CONCLUSIONS: Our preliminary study suggests that TCD could be used in pre-hospital care to detect patients whose cerebral perfusion may be impaired.
Authors: Franck Amyot; David B Arciniegas; Michael P Brazaitis; Kenneth C Curley; Ramon Diaz-Arrastia; Amir Gandjbakhche; Peter Herscovitch; Sidney R Hinds; Geoffrey T Manley; Anthony Pacifico; Alexander Razumovsky; Jason Riley; Wanda Salzer; Robert Shih; James G Smirniotopoulos; Derek Stocker Journal: J Neurotrauma Date: 2015-09-30 Impact factor: 5.269
Authors: Chiara Robba; Alberto Goffi; Thomas Geeraerts; Danilo Cardim; Gabriele Via; Marek Czosnyka; Soojin Park; Aarti Sarwal; Llewellyn Padayachy; Frank Rasulo; Giuseppe Citerio Journal: Intensive Care Med Date: 2019-04-25 Impact factor: 17.440
Authors: Shraddha Mainali; Danilo Cardim; Aarti Sarwal; Lisa H Merck; Sharon D Yeatts; Marek Czosnyka; Lori Shutter Journal: Neurocrit Care Date: 2022-04-06 Impact factor: 3.532
Authors: Mark D Whiting; Bradley A Dengler; Carissa L Rodriguez; David Blodgett; Adam B Cohen; Adolph J Januszkiewicz; Todd E Rasmussen; David L Brody Journal: Front Neurol Date: 2020-10-30 Impact factor: 4.003