Letter to the Editor. Computed tomography angiography in brain death determination: is there justification for its use?

Brain death is the state of irreversible loss of the clinical functions of the brain. A patient must meet strict criteria to be declared brain dead. They must have suffered a known and demonstrably irreversible brain injury and must not have a condition that could render neurologic testing unreliable. If the patient meets these criteria, a formal brain death examination can be performed. The three findings in brain death are coma or unresponsiveness, absence of brainstem reflexes, and apnea. Brain death is closely tied to organ donation, because brain-dead patients represent approximately 90% of deceased donors and thus a large majority of donated organs. This review details a definition and overview of brain death, determination of brain death, and controversy over brain death, as well as the types of organ donation (living donation versus deceased donation), donation after brain death, and donation after cardiac death. A figure presents a comparison of organ donation after brain death and after cardiac death, and a table lists the American Academy of Neurology Criteria for Determination of Brain Death. This review contains 1 highly rendered figure, 3 table, and 20 references.

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Analyzing EEG of Quasi-Brain-Death Based on Dynamic Sample Entropy Measures

Computational and Mathematical Methods in Medicine ◽

10.1155/2013/618743 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Li Ni ◽

Jianting Cao ◽

Rubin Wang

Keyword(s):

Brain Death ◽

Real Time ◽

Time Window ◽

Approximate Entropy ◽

Sample Entropy ◽

Well Performance ◽

Entropy Measures ◽

Brain Death Determination ◽

Death Determination ◽

The Brain

To give a more definite criterion using electroencephalograph (EEG) approach on brain death determination is vital for both reducing the risks and preventing medical misdiagnosis. This paper presents several novel adaptive computable entropy methods based on approximate entropy (ApEn) and sample entropy (SampEn) to monitor the varying symptoms of patients and to determine the brain death. The proposed method is a dynamic extension of the standard ApEn and SampEn by introducing a shifted time window. The main advantages of the developed dynamic approximate entropy (DApEn) and dynamic sample entropy (DSampEn) are for real-time computation and practical use. Results from the analysis of 35 patients (63 recordings) show that the proposed methods can illustrate effectiveness and well performance in evaluating the brain consciousness states.

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Brain Death Determination Practices in Children

JAMA ◽

10.1001/jama.1995.03530220027023 ◽

1995 ◽

Vol 274 (22) ◽

pp. 1761

Author(s):

Joan A. Lynch

Keyword(s):

Brain Death ◽

Brain Death Determination ◽

Death Determination

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The effect of incorporating an arterial pH target during apnea test for brain death determination

Journal of Intensive Care ◽

10.1186/s40560-020-00522-8 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Ibrahim Migdady ◽

Moein Amin ◽

Aaron Shoskes ◽

Catherine Hassett ◽

Sung-Min Cho ◽

...

Keyword(s):

Brain Death ◽

Cleveland Clinic ◽

Apnea Test ◽

Arterial Ph ◽

Common Etiology ◽

Brain Death Determination ◽

Blood Gas Analyses ◽

The Impact ◽

Death Determination ◽

Current Guidelines

Abstract Background Persistent apnea despite an adequate rise in arterial pressure of CO2 is an essential component of the criteria for brain death (BD) determination. Current guidelines vary regarding the utility of arterial pH changes during the apnea test (AT). We aimed to study the effect of incorporating an arterial pH target < 7.30 during the AT (in addition to the existing PaCO2 threshold) on brain death declarations. Methods We performed retrospective analysis of consecutive adult patients who were diagnosed with BD and underwent AT at the Cleveland Clinic over the last 10 years. Data regarding baseline and post-AT blood gas analyses were collected and analyzed. Results Ninety-eight patients underwent AT in the study period, which was positive in 89 (91%) and inconclusive in 9 (9%) patients. The mean age was 50 years old (standard deviation [SD] 16) and 54 (55%) were female. The most common etiology BD was hypoxic ischemic brain injury (HIBI) due to cardiac arrest (42%). Compared to those with positive AT, patients with inconclusive AT had a higher post-AT pH (7.24 vs 7.17, p = 0.01), lower PaO2 (47 vs 145, p < 0.01), and a lower PaCO2 (55 vs 73, p = 0.01). Among patients with a positive AT using PaCO2 threshold alone, the frequency of patients with post-AT pH < 7.30 was 95% (83/87). Conclusion Implementing a BD criteria requiring both arterial pH and PaCO2 thresholds reduced the total number of positive ATs; these inconclusive cases would have required longer duration of AT to reach both targets, repeated ATs, or ancillary studies to confirm BD. The impact of this on the overall number BD declarations requires further research.

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