1. 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 Prevalence and Mortality. Eight- Year Retrospective Review. H.I.G.A Prof. Dr Luis Güemes Buenos Aires, Argentina H.I.G.A Prof. Dr Luis Güemes Buenos Aires, Argentina

2. 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 deathOBJECTIVES 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

3. 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.

4. 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.

5. 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%) Trauma 335 pts (48%) SAH 122 pts (17%) ICH 125 pts (18%) Ischemic stroke 35 pts (5%) Medical 81 pts (12%) Excluded 13 patients CATEGORIES

6. RESULTS Annual Prevalence Rate for DC 30 % DC YesDC No 2003 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

7. RESULTS Annual Prevalence Rate for DBCN 20032004200520062007200820092010 DBCN No90%88%67%89%82%85%83%86% DBCNYes10%12%33%11%18%15%17%14% Chi square for linear trend 0.001 p value 0,97

8. 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 death Cardiac arrest 270 pts (65%) - DBNC 108 pts (26%) Excluded 40 pts (9%) not assessed completely for the diagnosis of DBNC Causes of death Cardiac arrest 270 pts (65%) - DBNC 108 pts (26%) Excluded 40 pts (9%) not assessed completely for the diagnosis of DBNC

9. RESULTS Evolution to DBNC 378 Patients death Group DC 86 pts Group without DC 292 pts 84 pts (29%) DBNC 24 pts (28%) DBNC No significant differences between groups

10. 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