Usefulness of (Tc 99m) HM-PAO scan in supporting clinical brain death in children: uncoupling flow and function.

Objective: To determine the usefulness of (Tc 99m) HM-PAO scan in supporting the clinical diagnosis of brain death.
Design: Retrospective review.
Setting: Paediatric Intensive Care Unit.
Subjects: A total of 39 paediatric patients had HM-PAO scans conducted to confirm the presence of brain death or to assess the degree of brain injury.
Interventions: All patients had (Tc 99m) HM-PAO injected before the scan was conducted.
Measurements and Main Results: Fifty-four scans were done in 39 patients. The majority of cerebral injury was as a result of closed head injury or asphyxia/anoxia. There were 20 scans which demonstrated no cerebral blood flow (CBF); however, in 26 situations patients were clinically brain dead. All of the patients who continued to have CBF in the presence of clinical brain death sustained asphyxial/anoxic injuries.
Conclusions: The HM-PAO scan is a useful non-invasive portable tool for supporting the diagnosis of brain death when there is absent CBF. However, continued flow may be present in asphyxial/anoxic injuries in the presence of clinical brain death.