Brain death

Criteria

Known proximate cause of condition
Exclusion of complicating medical conditions (severe electrolyte, acidbase, or endocrine disturbance)
No drug intoxication/poisoning
Core temp >32C (90F)
Cerebral unresponsiveness
Absence of brain stem relexes (see below)
Apneic (see below)
Irreversible condition (+/- repeat exam in 6hrs)

Pupils
1. no response to light (fixed and mid-dialated)
Ocular movement
1. no oculocephalic reflex (+Doll's Eyes)
2. no vestibulocochlear (deviation of eyes to irrigation w/ 50mL cold water to ears - allow 1 min after and 5 min b/t)
Facial motor response/sensation
1. jaw reflex (grimacing to deep facial pressure)
2. corneal reflex (touch eye w/ swab)
Paryngeal/tracheal
1. gag (tounge blade)

Prerequisites:
1. Clinical Criteria
  1. Must be diagnosis compatabile with brain death (SAH/ICH/TBI etc.)
2. Core temp >32 C (actual temp varies by institution) with corrected electrolytes. > 36.5C is preferred.
3. Exclusion of iatrogenic drug effects
  1. check urine tox fo ropiates or benzodiazepines and illicit drugs. Review med rec for sedating/paralytic meds (recent intubation/propofol infusion etc).
    1. if drug cannot be quantified. Patient observed for 4x half life of drug (drug levels ~5% of previous)
4. SBP >90
5. Nl PCO2 (>40)
6. Nl PO2 (preoxiginate >200)
Physical Exam (when to perform brain death)
1. must have no mention, no motor or sensory response. (no movement or hemodynamic response(increased tachycardia) to noxious stimulation).
Test:
1. Connect pulse ox, disconnect ventilator, place nasal cannula in ET (at carina), and place on 100% O2, observe for resp movements, draw ABG @ 8 min.
2. Pos test = 20 increase over baseline (typically 60) ensure to blow down CO2 to ~40 to enable 20mmHg rise.
3. reconnect ventilator if SBP <90 or sig O2 desat (can draw ABG @ that time, with same criteria as above).
4. Must perform 2 exams 6 hours apart in addition to apnea test.

One-Legacy 800-338-6112

2/8/07 DONALDSON (adapted from One-Legacy)

Authors: