Brief survey: Determining brain death in Canadian intensive care units

Abstract

Purpose: Criteria for brain death were first described in 1968, and Canadian guidelines were published in 1988. However, international inconsistency persists in the process of determining brain death. We sought to determine self-reported practices and processes in the determination of brain death amongst Canadian intensive care unit (ICU) physicians.Methods: An email survey of members of the Canadian Critical Care Society was undertaken. A survey instrument was developed, then face and content validated prior to distribution.Results: Eighty eight responded (response rate = 49%), including adult and pediatric ICU physicians working in both tertiary referral (academic) and community hospitals. Most respondents admit patients with brain death to their ICUs. However, 9% reported refusing to admit this type of patient for reasons including inappropriate utilization of ICU resources (36%), and lack of either space or staff (32% and 29% of respondents, respectively). Community hospital-based ICU physicians were less likely to report a hospital policy on the determination of brain death (46% vs 78% of physicians in tertiary care hospitals). Nearly all physicians (96%) reported that a revised national standard and checklist for the determination of death would be useful. Conclusions:Nearly one quarter, and over one half of tertiary care and community hospitals (respectively) in Canada lack an institutional policy on neurological determination of brain death. Canadian ICU physicians are interested in a national standard for the determination of death, and establishment of processes that may improve the clinical determination of death by neurological criteria. Objectif

Brain arrest to neurological determination of death to organ utilization: the evolution of hospitalbased organ donation strategies in Canada

“…Hornby et al 13 review Canadian hospital based adult and pediatric brain death guidelines, confirming the substantial and concerning inconsistencies in practices 14,15 and documentation 16 described in other countries. These observations confirm the need for a national standard to address diagnostic variability and improve documentation, as corroborated by a survey of Canadian critical care physicians by Doig et al 17 While the neurological determination of death is fundamentally a bedside evaluation documenting the absence of clinical brainstem function, the inability to complete all clinical criteria mandates the use of an ancillary test. Young et al 18 review the appropriate use of ancillary testing, abandoning the electroencephalogram in favour of tests that demonstrate the absence of intracranial blood flow.…”

“…Ces observations confirment la nécessité de normes nationales pour éliminer la variabilité diagnostique et améliorer la documentation, ce qui a été corroboré par une enquête auprès des médecins de soins intensifs canadiens menée par Doig et coll. 17 Alors que la détermination neurologique de la mort est essentiellement une évaluation faite au chevet du malade qui documente l'absence de fonction clinique du tronc cérébral, l'incapacité à répondre à tous les critères cliniques exige le recours à un test auxiliaire. Young et coll.…”

The clinical criteria of brain death throughout the world: why has it come to this?

“…The intensive care unit physician survey by Doig et al 8 confirms this need in the Canadian context. This would require a task force that reviews the data and provides evidentiary tables.…”

“…L'enquête menée auprès des médecins des unités de soins intensifs par Doig et coll. 8 confirme cette nécessité dans le contexte canadien. Il faudra une équipe spéciale pour revoir les données et fournir des tableaux probants.…”

Observations on the Ethical and Social Aspects of Disorders of Consciousness

“…Nonetheless, evidence from international studies suggests that institutions lack clear policies for the determination of death and that the use of tests during clinical examination varies [15][16][17][18][19] .…”