Pronouncing brain death

@article{Wijdicks2008PronouncingBD,
  title={Pronouncing brain death},
  author={Eelco F. M. Wijdicks and Alejandro A. Rabinstein and Edward M. Manno and John L. D. Atkinson},
  journal={Neurology},
  year={2008},
  volume={71},
  pages={1240 - 1244}
}
Background: Little is known of hospital practice in brain death determination, specialty involvement, and followed procedures, including the apnea test. Methods: We reviewed 228 patients pronounced brain dead at Mayo Clinic from 1996 to 2007. We performed a detailed review of clinical determination of brain death, intensive care support, apnea test procedure, and complications. Results: There were 228 patients who were pronounced brain dead, mostly after traumatic brain injury, cerebral… 
Brain Death in Children
TLDR
Brain death is a distinct mode of death in pediatric intensive care units, accounting for 16–23% of deaths, and two clinical examinations by qualified physicians at set intervals are required.
Completing the Apnea Test: Decline in Complications
TLDR
A major decrease in the number of aborted or not attempted apnea tests compared to previous studies is found andApnea determined using the oxygenation diffusion method during brain death testing is very safe, provided appropriate prerequisites are met.
Brain death.
  • E. Wijdicks
  • Psychology, Medicine
    Handbook of clinical neurology
  • 2013
TLDR
In this chapter, the history of development of the criteria, the current clinical examination, and some of the ethical and legal issues that have emerged are discussed.
The Challenges with Brain Death Determination in Adult Patients on Extracorporeal Membrane Oxygenation
TLDR
Apnea testing is essential in the determination of brain death, but may not be employed in ECMO-treated adult patients, and an oxygenated apnea test on ECMO is proposed using continuous positive airway pressure through the ventilator or anesthesia bag, with an inline manometer and an end tidal CO2 device.
Should ancillary brain blood flow analyses play a larger role in the neurological determination of death?
TLDR
Two patients who regained spontaneous respiration following clinical neurological determination of death (NDD) while ancillary radiological imaging demonstrated brain blood flow are presented to illustrate the difficulties encountered by experienced clinicians in determining brain death using clinical criteria alone and it is suggested that more routine use of anCillary brain water flow analyses should be recommended.
Update of Clinical Practice Guidelines for Brain Death Determination in an Academic Heath Center
TLDR
By updating the policy within the University of Cincinnati Medical Center, the clinicians have been equipped with the latest evidence to perform the clinical examination for diagnosis of BD and then appropriately communicate this diagnosis to the family.
A critique of the apneic oxygenation test for the diagnosis of “brain death”*
  • J. Tibballs
  • Medicine
    Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
  • 2010
TLDR
The apneic oxygenation test is unreliable in the diagnosis of brain death and should be restricted to demonstration of apnea after brain perfusion has been shown to be absent, whereas a reliable test ofbrain perfusion should be mandatory.
Apnea Testing for the Determination of Brain Death: A Systematic Scoping Review
TLDR
A systematic scoping review of the literature on AT in English language available in PubMed or EMBASE since 1980 sought to review described modifications of AT, safety and complication rates, monitoring techniques, performance of AT on extracorporeal membrane oxygenation (ECMO), and other relevant considerations regarding AT.
Special considerations in the assessment of catastrophic brain injury and determination of brain death in patients with SARS-CoV-2
TLDR
The evaluation of six patients hospitalized at a health network in New York City in April 2020 who had Covid-19, were comatose and had absent brainstem reflexes is described, finding it feasible to evaluate patients with catastrophic brain injury and declare brain death despite the Covids-19 pandemic.
Identification of Hemodynamic Risk Factors for Apnea Test Failure During Brain Death Determination.
TLDR
Early recognition and aggressive management for the risk factors are important to reduce failure rates of apnea test and consequently improve outcomes of organ procurement.
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