Revised, Evidence-Based Brain Death Guideline Issued

Insufficient evidence available to determine if new ancillary tests accurately identify brain death
By Lindsey Marcellin
HealthDay Reporter

MONDAY, June 7 (HealthDay News) -- A new guideline for determining brain death has been issued by the American Academy of Neurology, updating the 1995 version and including a checklist to provide doctors with clarity and direction. The guideline has been published in the June 8 issue of Neurology.

Eelco F.M. Wijdicks, M.D., of the Mayo Clinic in Rochester, Minn., and colleagues performed a systematic literature search looking for answers to specific questions, including: "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 no published reports of adults regaining brain function after a diagnosis of brain death, and there was not enough evidence to determine the minimum time needed for observation of a patient before pronouncing permanent, irreversible, brain death. Complex-spontaneous motor movements have been reported after brain death. The researchers did not find sufficient evidence to establish if new, ancillary brain-death determination tests accurately determine cessation of brain activity, but found apneic oxygenation diffusion to be a safe method.

"Future prospective studies of brain death determination are needed. Areas of future research include examining the safety of the apnea test, seeking alternative methods of apnea testing, performing an audit of adequate documentation, and studying the competence of examiners. Details of the neurologic examination may be subjected to an expert panel review, possibly including international organizations," the authors write.

The authors disclosed financial ties to the pharmaceutical and medical device industries.

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