Critical Matters Death By Neurologic Criteria
Nov 12, 2020
In this discussion, Dr. David Greer, Chair of Neurology at Boston University, delves into the complexities of brain death and the World Brain Death Project. He emphasizes the importance of conservative diagnostic criteria to prevent misdiagnosis. Greer explains necessary prerequisites for brain death testing, the significance of the apnea test, and the role of ancillary testing. He also highlights the ethical challenges families face and the need for precise documentation in declaring time of death, ensuring clarity and trust in critical care.
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Global Minimum Criteria Matter
- The World Brain Death Project aims to create minimum global criteria to ensure consistent, conservative brain death determinations.
- The goal is near-zero false positives so death isn't declared in one place but not another.
Confirm Irreversibility And Remove Confounders
- Before testing, confirm the cause is a catastrophic, irreversible brain injury and exclude reversible confounders like drugs, metabolic derangements, hypothermia, and neuromuscular blockade.
- Wait appropriate drug half-lives and adjust for liver/renal dysfunction before proceeding.
Follow The Three-Part Clinical Exam
- Perform a full clinical determination: confirm coma, complete absence of brainstem reflexes, and a formal apnea test.
- Use apnea testing to assess medullary respiratory drive as the final clinical step.
