Determination of Brain Death/Death by Neurologic Criteria: The World Brain Death Project
Language English Country United States Media print
Document type Consensus Development Conference, Journal Article, Practice Guideline
PubMed
32761206
DOI
10.1001/jama.2020.11586
PII: 2769149
Knihovny.cz E-resources
- MeSH
- Apnea diagnosis MeSH
- Biomedical Research MeSH
- Diagnosis, Differential MeSH
- Coma diagnosis MeSH
- Humans MeSH
- Brain Death diagnosis physiopathology MeSH
- Brain Stem physiopathology MeSH
- Nervous System Physiological Phenomena * MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Consensus Development Conference MeSH
- Practice Guideline MeSH
IMPORTANCE: There are inconsistencies in concept, criteria, practice, and documentation of brain death/death by neurologic criteria (BD/DNC) both internationally and within countries. OBJECTIVE: To formulate a consensus statement of recommendations on determination of BD/DNC based on review of the literature and expert opinion of a large multidisciplinary, international panel. PROCESS: Relevant international professional societies were recruited to develop recommendations regarding determination of BD/DNC. Literature searches of the Cochrane, Embase, and MEDLINE databases included January 1, 1992, through April 2020 identified pertinent articles for review. Because of the lack of high-quality data from randomized clinical trials or large observational studies, recommendations were formulated based on consensus of contributors and medical societies that represented relevant disciplines, including critical care, neurology, and neurosurgery. EVIDENCE SYNTHESIS: Based on review of the literature and consensus from a large multidisciplinary, international panel, minimum clinical criteria needed to determine BD/DNC in various circumstances were developed. RECOMMENDATIONS: Prior to evaluating a patient for BD/DNC, the patient should have an established neurologic diagnosis that can lead to the complete and irreversible loss of all brain function, and conditions that may confound the clinical examination and diseases that may mimic BD/DNC should be excluded. Determination of BD/DNC can be done with a clinical examination that demonstrates coma, brainstem areflexia, and apnea. This is seen when (1) there is no evidence of arousal or awareness to maximal external stimulation, including noxious visual, auditory, and tactile stimulation; (2) pupils are fixed in a midsize or dilated position and are nonreactive to light; (3) corneal, oculocephalic, and oculovestibular reflexes are absent; (4) there is no facial movement to noxious stimulation; (5) the gag reflex is absent to bilateral posterior pharyngeal stimulation; (6) the cough reflex is absent to deep tracheal suctioning; (7) there is no brain-mediated motor response to noxious stimulation of the limbs; and (8) spontaneous respirations are not observed when apnea test targets reach pH <7.30 and Paco2 ≥60 mm Hg. If the clinical examination cannot be completed, ancillary testing may be considered with blood flow studies or electrophysiologic testing. Special consideration is needed for children, for persons receiving extracorporeal membrane oxygenation, and for those receiving therapeutic hypothermia, as well as for factors such as religious, societal, and cultural perspectives; legal requirements; and resource availability. CONCLUSIONS AND RELEVANCE: This report provides recommendations for the minimum clinical standards for determination of brain death/death by neurologic criteria in adults and children with clear guidance for various clinical circumstances. The recommendations have widespread international society endorsement and can serve to guide professional societies and countries in the revision or development of protocols and procedures for determination of brain death/death by neurologic criteria, leading to greater consistency within and between countries.
Albany Medical College Albany New York
Boston University School of Medicine Boston Massachusetts
Canadian Blood Services Ottawa Canada
Capital Medical University Beijing China
Clínica Alemana Universidad del Desarrollo Santiago Chile
College of Nursing University of Tennessee Health Science Center Memphis
Department of Neurology Hacettepe University Ankara Turkey
Dubai Hospital Dubai United Arab Emirates
Fundación Valle del Lili Cali Colombia
Geisel School of Medicine at Dartmouth Hanover New Hampshire
Hospital Clinic Universitari University of Valencia Valencia Spain
Hospital Universitario Austral Buenos Aires Argentina
Indiana University Indianapolis
J E Purkinje University Masaryk Hospital Usti nad Labem Czech Republic
Kagawa University Kagawa Japan
McGill University Montreal Children's Hospital Montreal Canada
Mitchell Hamline School of Law Saint Paul Minnesota
Montreal Neurological Institute Montreal Canada
National Hospital Alejandro Posadas Buenos Aires Argentina
National Institute of Neurosciences and Hospital Dhaka Bangladesh
Northwestern University Feinberg School of Medicine Chicago Illinois
NYU Langone Medical Center New York New York
Queen's Medical Center Honolulu Hawaii
Research Center of Neurology Moscow Russia
Seoul National University Bundang Hospital Seoul Republic of Korea
Sir Charles Gairdner Hospital Nedlands Australia
Southmead Hospital Bristol United Kingdom
St Michael's Hospital Unity Health Toronto and University of Toronto Toronto Canada
The University of Texas Health Science Center at Houston Houston
The University of Toronto Toronto Canada
Tribhuvan University Teaching Hospital Kathmandu Nepal
University Milano Bicocca Milano Bicocca Italy
University of Cape Town Cape Town South Africa
University of Chicago Chicago Illinois
University of Florida Jacksonville
University of Melbourne Melbourne Australia
University of Pittsburgh Medical Center Pittsburgh Pennsylvania
University of Southern California Los Angeles
University of Sydney and Children's Hospital of Westmead Westmead Australia
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