Guidelines for the Determination of Brain Death in Infants and Children: An Update of the 1987 Task Force Recommendations

Nakagawa, Thomas A.; Ashwal, Stephen; Mathur, Mudit; Mysore, Mohan R.

doi:10.1542/peds.2011-1511

Cited by 187 publications

(135 citation statements)

References 84 publications

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“…The clinical brain death diagnosis is based on the three brain stem criteria: total and irreversible coma with a known cause, the absence of brain stem reflexes, and apnoea [ 2 ]. However, determining these clinical criteria may be hindered by complex or spontaneous motor movements; false-positive triggering of the ventilator [ 1 ]; or particular contexts, such as barbituric impregnation, hypothermia, haemodynamic instability, drug intoxication, or immature central nervous system in young children [ 3 ]. Thus, a brain death diagnosis may require confirmatory tests, which are mandatory in several countries.…”

Section: Introductionmentioning

confidence: 99%

Revised CT angiography venous score with consideration of infratentorial circulation value for diagnosing brain death

Marchand

Séguin

Malledant

et al. 2016

Ann. Intensive Care

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BackgroundComputed tomography angiography (CTA) is largely performed in European countries as an ancillary test for diagnosing brain death. However, CTA suffers from a lack of sensitivity, especially in patients who have previously undergone decompressive craniectomy. The aim of this study was to assess the performance of a revised four-point venous CTA score, including non-opacification of the infratentorial venous circulation, for diagnosing brain death.MethodsA preliminary study of 43 control patients with normal CTAs confirmed that the infratentorial superior petrosal vein (SPV) was consistently visible. Therefore, 76 patients (including ten with decompressive craniectomy) who were investigated with 83 CTAs to confirm clinical brain death were consecutively enrolled between July 2011 and July 2013 at a university centre. The image analysis consisted of recording non-opacification of the cortical segment of the middle cerebral artery and internal cerebral vein (ICV), which were used as the reference CTA score, as well as non-opacification of the SPV. The diagnostic performance of the revised four-point venous CTA score based on the non-opacification of both the ICV and SPV was assessed and compared with that of the reference CTA score.ResultsThe revised four-point venous CTA score showed a sensitivity of 95 % for confirming clinical brain death versus a sensitivity of 88 % with the reference CTA score. Non-opacification of the SPV was observed in 95 % of the patients. In the decompressive craniectomy group, the revised four-point CTA score showed a sensitivity of 100 % compared with a sensitivity of 80 % using the reference CTA score.ConclusionCompared with the reference CTA score, the revised four-point venous CTA score based on ICV and SPV non-opacification showed superior diagnostic performance for confirming brain death, including for patients with decompressive craniectomy.

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Section: Introductionmentioning

confidence: 99%

Revised CT angiography venous score with consideration of infratentorial circulation value for diagnosing brain death

Marchand

Séguin

Malledant

et al. 2016

Ann. Intensive Care

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“…There is no sufficient evidence to determine the minimally acceptable observation period between clinical exams; role of newer ancillary tests and safety of apnea test techniques. [3439] Future research should be directed towards these issues. Although guidelines are available in many countries for the diagnosis of brain-death, the variations and inconsistencies necessitate an international consensus and uniform guidelines.…”

Section: Resultsmentioning

confidence: 99%

“…[363738] In the same year, the Society of Critical Care Medicine of the American Academy of Pediatrics issued an update of the guidelines for the determination of brain-death in infants and children. [39]…”

Section: Historical Glimpsementioning

confidence: 99%

Brainstem death: A comprehensive review in Indian perspective

Dhanwate¹

2014

Indian Journal of Critical Care Medicine

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With the advent of cardiopulmonary resuscitation techniques, the cardiopulmonary definition of death lost its significance in favor of brain death. Brain death is a permanent cessation of all functions of the brain in which though individual organs may function but lack of integrating function of the brain, lack of respiratory drive, consciousness, and cognition confirms to the definition that death is an irreversible cessation of functioning of the organism as a whole. In spite of medical and legal acceptance globally, the concept of brain death and brain-stem death is still unclear to many. Brain death is not promptly declared due to lack of awareness and doubts about the legal procedure of certification. Many brain dead patients are kept on life supporting systems needlessly. In this comprehensive review, an attempt has been made to highlight the history and concept of brain death and brain-stem death; the anatomical and physiological basis of brain-stem death, and criteria to diagnose brain-stem death in India.

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“…An age-dependent period of observation between the two examinations is required to diagnose brain death. In 2011, the AAP provided an important update of the guidelines ( 18 ). Clinicians can now diagnose brain death in term newborns defined as 37 weeks gestational age or greater.…”

Section: Donation After Brain Deathmentioning

confidence: 99%

Neonatal and Pediatric Organ Donation: Ethical Perspectives and Implications for Policy

Sarnaik

2015

Front. Pediatr.

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The lifesaving processes of organ donation and transplantation in neonatology and pediatrics carry important ethical considerations. The medical community must balance the principles of autonomy, non-maleficence, beneficence, and justice to ensure the best interest of the potential donor and to provide equitable benefit to society. Accordingly, the US Organ Procurement and Transplantation Network (OPTN) has established procedures for the ethical allocation of organs depending on several donor-specific and recipient-specific factors. To maximize the availability of transplantable organs and opportunities for dying patients and families to donate, the US government has mandated that hospitals refer potential donors in a timely manner. Expedient investigation and diagnosis of brain death where applicable are also crucial, especially in neonates. Empowering trained individuals from organ procurement organizations to discuss organ donation with families has also increased rates of consent. Other efforts to increase organ supply include recovery from donors who die by circulatory criteria (DCDD) in addition to donation after brain death (DBD), and from neonates born with immediately lethal conditions such as anencephaly. Ethical considerations in DCDD compared to DBD include a potential conflict of interest between the dying patient and others who may benefit from the organs, and the precision of the declaration of death of the donor. Most clinicians and ethicists believe in the appropriateness of the Dead Donor Rule, which states that vital organs should only be recovered from people who have died. The medical community can maximize the interests of organ donors and recipients by observing the Dead Donor Rule and acknowledging the ethical considerations in organ donation.

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Guidelines for the Determination of Brain Death in Infants and Children: An Update of the 1987 Task Force Recommendations

Cited by 187 publications

References 84 publications

Revised CT angiography venous score with consideration of infratentorial circulation value for diagnosing brain death

Revised CT angiography venous score with consideration of infratentorial circulation value for diagnosing brain death

Brainstem death: A comprehensive review in Indian perspective

Neonatal and Pediatric Organ Donation: Ethical Perspectives and Implications for Policy

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