Determining brain death in adults [RETIRED

Abstract

Overview. The Quality Standards Subcommittee of the American Academy of Neurology (AAN) is charged with developing guidelines for neurologists for diagnostic procedures, treatment modalities, and clinical disorders. The present document is intended to provide background for the report “Practice Parameters for Determining Brain Death in Adults” (in this issue), which has been produced by the Quality Standards Subcommittee of the AAN and approved by the AAN Executive Board. This document outlines diagnostic criteria for the chical diagnosis of brain death in patients older than 18 years. The recommendations for diagnosis in neonates and children have been published as a position paper by the American Academy of Pediatrics’; in addition, a review paper can be consulted.‘ The sensitivity and specificity of laboratory tests that confirm the clinical diagnosis of brain death are discussed. Justification. Brain death is seen frequently as a result of severe head injury, aneurysmal subarachnoid hemorrhage, and intracerebral hem~rrhage.~.~ In medical and surgical intensive care units, large ischemic strokes associated with brain swelling and herniation, hypoxic-ischemic encephalopathy after prolonged cardiac resuscitation or asphyxia, and massive brain edema in patients with fulminant hepatic necrosis are the most common causes of brain death.7-9 In large referral hospitals, neurologists or neurosurgeons may diagnose brain death