Variability in Pediatric Brain Death Determination and Documentation in Southern California

Mathur, Mudit; Petersen, LuCyndi; Stadtler, Maria; Rose, Colleen; Ejike, J. Chiaka; Petersen, Floyd; Tinsley, Cynthia; Ashwal, Stephen

doi:10.1542/peds.2007-1871

Cited by 53 publications

(27 citation statements)

References 14 publications

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“…The neurological criteria, as outlined above, represent international practice in which the medical profession and the public can have complete confidence [16]. The use of checklist promotes the necessary documentation of each part of declaration of BD and is strongly recommended [2,21,24]. International guidelines should form a basis where national guidelines could be established, taking into account legal, ethical, cultural, and religious differences.…”

Section: Discussionmentioning

confidence: 99%

“…Apnea testing is the cornerstone for the diagnosis of BD both in adults and children and is conducted similar to adults. However, despite the consensus criteria published for adults and pediatrics, considerable variation has been described in performing the apnea test in both populations [2,21,22,29]. In 1987 Task Force guidelines for pediatric BD is reported that apnea testing using standardized methods can be performed, but this is ordinarily done only after other examination criteria are met.…”

Section: Apnea Testmentioning

confidence: 99%

“…Documentation at each step of diagnosis is necessary, starting from the preconditions that should be met and finishing with the exact time of death, accompanied by the well written names and signatures of the responsible physicians. The use of a checklist provides standardized documentation to determine brain death ensuring that no step is missing and is highly recommended [20,21,24]. A checklist outlining essential examination and testing components is provided in Appendix 2.…”

Section: Declaration Of Death: Documentationmentioning

confidence: 99%

“…BD in most occasions is intertwined to organ harvesting and transplantation, and much research in the field has been done through national organ procurement databases [21,22]. Nevertheless, the declaration of BD should be done by the patient physicians only, according to local national and institutional guidelines, irrespective from the transplantation team [23,24].…”

Section: Introductionmentioning

confidence: 99%

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Brain Death in Children

Volakli¹,

Mantzafleri²,

SerafeiaKalamitsou³

et al. 2017

Intensive Care

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Brain death (BD) is a distinct mode of death in pediatric intensive care units, accounting for 16-23% of deaths. Coma, absent brainstem reflexes, and apnea in a patient with acute irreversible neurological insult should alarm the attending physician to start the appropriate actions to establish or refute the diagnosis for BD. BD diagnosis is clinical, starting with the preconditions that should be met, and based on the examination of all brainstem reflexes, including the apnea test. Apnea testing should be conducted according to standard criteria to demonstrate the absence of spontaneous respirations, in the case of an intense ventilatory stimulus, setting at increased PaCO 2 levels ≥60 and ≥20 mm Hg, compared to baseline. When elements of clinical examination and/or apnea test cannot be performed, ancillary studies to demonstrate the presence/absence of electrocerebral silence and/or cerebral blood flow are guaranteed. Two clinical examinations by qualified physicians at set intervals are required. Time of death is the time of second examination and ventilator support should stop at that time, except for organ donation. The use of check list in documentation of BD helps in the uniformity of diagnosis and fosters further trust from medical, family, and community personnel.

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Section: Discussionmentioning

confidence: 99%

Section: Apnea Testmentioning

confidence: 99%

Section: Declaration Of Death: Documentationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Brain Death in Children

Volakli¹,

Mantzafleri²,

SerafeiaKalamitsou³

et al. 2017

Intensive Care

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“…In this scenario, it is not surprising that supporters of transplants are advocating that confirmatory tests should not be performed in order to avoid delay 22 . More worrying is what was revealed in a study involving 142 pediatric donors with beating heart, in which, after having passed through 294 neurological examinations, it was found that in only one of them the documentation of all components of the test was complete, only 26% had the apnea test properly performed, only 15% had two clinical examinations with appropriate time interval between them and only 58% had undergone confirmatory angiography 23 . Similar results were also found in studies with adult donors 24 .…”

Section: Inconsistencies Of the Biological Diagnosis Of Brain Deathmentioning

confidence: 96%

Morte encefálica: uma discussão encerrada?

Filho

Junges

2015

Rev. Bioét.

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This article is a narrative review of the main authors who establish objections to the use of the concept of brain death as a synonym for death. It focuses on their biological and philosophical inconsistencies of the concept and proposes the discussion of the topic using the epistemological concepts of Popper and Kuhn. The article adopts the concepts of biopower and biopolitics as tools in the analysis of brain death, especially in relation to the inevitable intersection with organ donation and transplants. Keywords: Brain death. Bioethics. Transplantation. ResumoMorte encefálica: uma discussão encerrada? O presente artigo faz revisão narrativa dos principais autores que estabelecem objeções à utilização do conceito de morte encefálica como sinônimo de morte, com foco em suas inconsistências biológicas e filosóficas. Propõe a discussão do tema recorrendo aos conceitos epistemológicos de Popper e Kuhn. Utiliza os conceitos de biopoder e biopolítica como ferramentas de análise da morte encefálica, especialmente no que concerne a sua inevitável intersecção com a doação e transplantes de órgãos. Palavras-chave: Morte encefálica. Bioética. Transplante. Resumen Muerte cerebral: ¿una discusión cerrada?Este artículo es una revisión narrativa de los principales autores que establecen excepciones a la utilización del concepto de muerte cerebral como sinónimo de muerte, centrándose en sus inconsistencias biológicas y filosóficas. Se propone la discusión del tema usando los conceptos epistemológicos de Popper y Kuhn. Utiliza los conceptos de biopoder y de biopolítica como herramientas en el análisis de la muerte cerebral, especialmente en relación con la intersección inevitable con los trasplantes de donación de órganos. Palavras-clave: Muerte encefálica. Bioética. Transplante.

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Determination of Brain Death/Death by Neurologic Criteria

Greer

Shemie

Lewis

et al. 2020

JAMA

453

533

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ImportanceThere are inconsistencies in concept, criteria, practice, and documentation of brain death/death by neurologic criteria (BD/DNC) both internationally and within countries.ObjectiveTo 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.ProcessRelevant 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 SynthesisBased 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.RecommendationsPrior 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 RelevanceThis 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...

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Variability in Pediatric Brain Death Determination and Documentation in Southern California

Cited by 53 publications

References 14 publications

Brain Death in Children

Brain Death in Children

Morte encefálica: uma discussão encerrada?

Determination of Brain Death/Death by Neurologic Criteria

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