scholarly journals Delayed and prolonged time for donor management including brain death determination

2021 ◽  
Vol 35 (1) ◽  
pp. S188-S188
Author(s):  
Jungsun Kim ◽  
Jisun Kwon ◽  
Seungrye Jeong ◽  
Miyoung Kim ◽  
Minyoung Chu ◽  
...  
Keyword(s):  
Brain Death ◽  
Donor Management ◽  
Prolonged Time ◽  
Brain Death Determination ◽  
Death Determination

Brain Death and Organ Donation

2018 ◽  
Author(s):  
Thomas I. Cochrane
Keyword(s):  
Brain Death ◽  
Organ Donation ◽  
Cardiac Death ◽  
Donation After Cardiac Death ◽  
Donation After Brain Death ◽  
Brain Death Determination ◽  
Brain Dead ◽  
American Academy Of Neurology ◽  
Death Determination

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.

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

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
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.

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

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.

The implementation of a protocol promoting the safe practice of brain death determination

2015 ◽  
Vol 30 (1) ◽  
pp. 107-110 ◽  
Author(s):  
Jonathan Cohen ◽  
Avraham Steinberg ◽  
Pierre Singer ◽  
Tamar Ashkenazi
Keyword(s):  
Brain Death ◽  
Safe Practice ◽  
Brain Death Determination ◽  
Death Determination

Brain Death, Organ Donation, and Transplantation

2018 ◽  
pp. 276-285
Author(s):  
Hilary H. Wang ◽  
David M. Greer
Keyword(s):  
Brain Death ◽  
Organ Donation ◽  
The United States ◽  
Apnea Test ◽  
Unit Management ◽  
Legal Context ◽  
History Of ◽  
Brain Death Determination ◽  
Brain Dead ◽  
Death Determination

This chapter reviews the history of brain death determination, current guidelines for performing the brain death examination including the apnea test, details of apnea testing, the role of brain dead donors in organ donation, physiologic changes seen in brain dead patients, and the relevant challenges in intensive care unit management of such patients for donor organ optimization. The goal of this chapter is to provide clear guidance for a critical care provider to perform an accurate and thorough brain death examination and to further the reader’s understanding of the historical and legal context surrounding brain death and organ donation in the United States.

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