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Brain death is the permanent absence of cerebral and brainstem functions (coma, absent pupillary reflexes, no spontaneous respiration, etc.). Legally, brain death is equivalent to cardiopulmonary death.
- Prior to brain death testing, ensure the following:
- SBP > 100, core temp >36 Celsius, and absent brainstem reflexes.
- An identified cause of brain death.
- No metabolic abnormalities or intoxication.
- CNS insult on imaging.
If brain death is suspected, confirmation is necessary. The apnea test is most commonly used, evaluating for spontaneous breaths when disconnected from the ventilator. If apnea testing is not possible (e.g., ambiguous clinical exam or cardiopulmonary instability) ancillary testing is needed:
- EEG
- Evoked potentials
- Cerebral angiography
- CT Angiogram
- MR Angiography
- Transcranial Doppler
- Nuclear Medicine
References
Wijdicks EF, The diagnosis of brain death. N Engl J Med. 2001 Apr 19;344(16):1215-21.