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Mechanism of Death after Decompressive Craniectomy in Non-Traumatic Brain Injury

  • Kimberley Trickey (a1), Laura Hornby (a2), Sam D. Shemie (a3) and Jeanne Teitelbaum (a4)

Abstract

Decompressive craniectomy (DC) after devastating brain injury (DBI) may influence the manner in which patients die, having implications for end-of-life care and organ donation. We performed a retrospective review of deaths following a non-traumatic DBI between 2008 and 2012. 160 patients were reviewed; 26 were treated with DC and 134 received standard care. There was no relationship between DC and mechanism of death, (OR 1.18, 95% CI 0.44-3.17). Prospective studies are required to confirm these preliminary finding. DC studies should report the mechanism of death.

Mécanismes du décès et craniectomie de décompression à la suite d’une lésion cérébrale non-traumatique. À la suite de lésions cérébrales sévères, la craniectomie de décompression (CD) peut influencer la façon dont les patients décèdent, en plus d’avoir une incidence sur les soins de fin de vie et le don d’organes. Nous avons ainsi mené une analyse rétrospective des décès survenus entre 2008 et 2012 à la suite de lésions cérébrales sévères non-traumatiques. Pour ce faire, nous avons passé en revue 160 dossiers de patients : 26 d’entre eux avaient été traités au moyen de la CD alors que 134 avaient bénéficié de soins standards. Aucun lien n’a été trouvé entre la CD et des mécanismes du décès (ratio d’incidence rapproché ou RIR=1,18 ; IC95% = 0,44-3,17). Des études prospectives sont donc nécessaires pour confirmer ces conclusions préliminaires. De plus, les études menées au sujet de la CD devraient veiller à signaler le mécanisme du décès en cause.

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Copyright

Corresponding author

Correspondence to: Sam D. Shemie, Division of Critical Care, Montreal Children’s Hospital, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, Canada, H4A 3J1. Email: sam.shemie@mcgill.ca.

References

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1. Academy of the Medical Royal Colleges. A Code of Practice for the Diagnosis and Confirmation of Death. 2008 [cited 2015 September]; Available from: http://www.bts.org.uk/Documents/A CODE OF PRACTICE FOR THE DIAGNOSIS AND CONFIRMATION OF DEATH.pdf.
2. Shemie, SD, Doig, C, Belitsky, P. Advancing toward a modern death: the path from severe brain injury to neurological determination of death. CMAJ. 2003;168:993-995.
3. Bendorf, A, et al. An international comparison of the effect of policy shifts to organ donation following cardiocirculatory death (DCD) on donation rates after brain death (DBD) and transplantation rates. PLoS One. 2013;8:e62010.
4. Taylor, A, et al. A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv Syst. 2001;17:154-162.
5. Vahedi, K, et al. Sequential-design, multicenter, randomized, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL Trial). Stroke. 2007;38:2506-2517.
6. Juttler, E, et al. Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY): a randomized, controlled trial. Stroke. 2007;38:2518-2525.
7. Hofmeijer, J, et al. Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol. 2009;8:326-333.
8. Pereyra, C, et al. Decompressive craniectomy and brain death prevalence and mortality: 8-year retrospective review. Transplant Proc. 2012;44:2181-2184.
9. Zeiler, FA, Trickey, K, Hornby, L, Shemie, SD, Lo, BWY, Teitelbaum, J. Decompressive Craniectomy and Mechanism of Death in Patients with a Traumatic Catastrophic Brain Injury. Trauma. 2016; In Press.

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Mechanism of Death after Decompressive Craniectomy in Non-Traumatic Brain Injury

  • Kimberley Trickey (a1), Laura Hornby (a2), Sam D. Shemie (a3) and Jeanne Teitelbaum (a4)

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