Critical Matters Death by Neurologic Criteria
Jul 14, 2022
Dr. David Greer, a leading neurologist and chair of the neurology department at Boston University, delves into the crucial topic of brain death. He explains the World Brain Death Project's goals to standardize brain death determination practices. Interesting discussions include the challenges of accurately determining brain death, the importance of detailed clinical examinations, and the role of ancillary testing. Dr. Greer emphasizes the need for meticulousness and conservative approaches in these life-and-death decisions, making it vital for clinicians to familiarize themselves with best practices.
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Two Independent Exams Are Preferable
- Two independent examinations increase diagnostic security; blinded examiners are ideal.
- Temporal separation lacks physiologic justification and is often a logistical, not clinical, requirement.
Reserve Ancillary Tests For Incomplete Exams
- Use ancillary tests only when clinical testing cannot be completed or confounders remain.
- Always perform the full clinical exam first; ancillary tests do not replace it.
Flow Studies Trump EEG For Ancillary Testing
- Flow studies are preferred over electrical tests for ancillary detection of absent cerebral circulation.
- Catheter digital subtraction angiography remains the gold standard despite logistical limits.
