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.

DECOMPRESSIVE CRANIECTOMY AND BRAIN DEATH

Prevalence and Mortality. Eight-Year Retrospective Review.

H.I.G.A Prof. Dr Luis GüemesBuenos Aires, Argentina

H.I.G.A Prof. Dr Luis GüemesBuenos Aires, Argentina

Decompressive craniectomy (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.

INTRODUCTION

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

698

patients

711

patients

Death

418 patients

60%

Survived

280 patients

40%

Trauma 335 pts (48%)SAH 122 pts (17%)ICH 125 pts (18%)Ischemic stroke 35 pts (5%)Medical 81 pts (12%)

Excluded13 patients

CATEGORIES

RESULTS Annual Prevalence Rate for DC

2003 2004 2005 2006 2007 2008 2009 20100%

10%

20%

30%

40%

50%

60%

70%

80%

30 %

DC Yes DC No2003 25% 75%2004 37% 63%

2005 22% 78%

2006 28% 72%2007 22% 78%2008 42% 58%2009 28% 72%2010 37% 63%

Chi square for linear trend 4.07 p value 0,043

RESULTS Annual Prevalence Rate for DBCN

1

2

3

4

5

6

7

8

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

2010

2009

2008

2007

2006

2005

2004

2003

16 %

2003 2004 2005 2006 2007 2008 2009 2010

DBCN No 90% 88% 67% 89% 82% 85% 83% 86%

DBCNYes 10% 12% 33% 11% 18% 15% 17% 14%

Chi square for linear trend 0.001 p value 0,97

RESULTS

698

patients

Group DC

206 pts• Death 98 pts (48%)

Group without DC

492 pts• Death 320 pts (65%)

p <0.001, RR 0.73, IC95 0.62-0.86

Mortality

Causes of deathCardiac arrest 270 pts (65%) - DBNC 108 pts (26%)

Excluded 40 pts (9%) not assessed completely for the diagnosis of DBNC

RESULTS Evolution to DBNC

378Patients death

Group DC86 pts

Group without DC

292 pts 84 pts (29%) DBNC

24 pts (28%) DBNC

No significant differences between groups

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

Thank you for your attention