New Guidelines for Determining Brain Death in Adults

For the first time in 15 years, The American Academy of Neurology (AAN; Saint Paul, MN, USA) has released new guidelines for determining brain death in adults, providing step-by-step instructions to help guide clinical decision making.

Researchers at the Mayo Clinic (Rochester, MN, USA), the University of Kansas (Kansas City, USA), and other institutions conducted a systematic literature search and review of MEDLINE and EMBASE studies from January 1996 to May 2009; the studies were limited to adults. The aim of the review was to provide an update of the 1995 AAN guideline with regard to the following questions: Are there patients who fulfill the clinical criteria of brain death who recover neurologic function? What is an adequate observation period to ensure that cessation of neurologic function is permanent? Are complex motor movements that falsely suggest retained brain function sometimes observed in brain death? What is the comparative safety of techniques for determining apnea? Are there new ancillary tests that accurately identify patients with brain death?

The researchers found that in adults, there are no published reports of recovery of neurologic function after a diagnosis of brain death using the criteria reviewed in the 1995 AAN practice parameter. Complex spontaneous-motor movements and false-positive triggering of the ventilator, however, may occur in patients who are brain dead. There is insufficient evidence to determine the minimally acceptable observation period to ensure that neurologic functions have ceased irreversibly. Apneic oxygenation diffusion to determine apnea is safe, but there is insufficient evidence to determine the comparative safety of techniques used for apnea testing. In conclusion, the researchers determined that there is insufficient evidence to determine if newer ancillary tests accurately confirm the cessation of function of the entire brain. The updated guidelines were published in the June 8, 2011, issue of Neurology.

“The brain death diagnosis can be made only after a comprehensive clinical evaluation and often involves more than 25 separate assessments,” said lead author Eelco Wijdicks, MD, of the Mayo Clinic. “To correctly diagnose brain death, it is essential clinicians adhere to a uniform framework.”

The authors reaffirmed that more than one exam is not required in the new brain death guidelines.

Related Links:
American Acasemy of Neurology
Mayo Clinic
University of Kansas