Diagnosis of Brain Death in a Multidisciplinary Hospital

Abstract

Brain death diagnosis (BDD) remains a challenge for anesthesiologists and intensive care physicians despite existing regulatory frameworks.Objective: To evaluate the frequency of BDD procedure and identify factors limiting its implementation in a multidisciplinary hospital setting.Materials and Methods: A single-center retrospective study was conducted including 698 patients by total sampling. Of these, 98 (14%) had brain injury and were selected for further analysis. From this cohort, patients who died within 15 days of hospital admission (n=61) were identified. A subgroup of patients with a Glasgow Coma Scale (GCS) score of 3-5 was then selected (n=38). For comparison, a literature search was performed in PubMed using the query “brain death criteria” and in eLibrary.ru using the keywords “brain death diagnosis”.Results: BDD was initiated in 12 (31.6%) cases within the GCS 3-5 subgroup, with brain death confirmed in 8 (21.1%) patients, including 5 (63%) women and 3 (37%) men. Complete BDD procedures were performed in 6 (75%) patients with non-traumatic intracerebral hemorrhage (ICH), 1 with non-traumatic subarachnoid hemorrhageь (SAH), and 1 with traumatic brain injury (TBI) (12.5% each). The median patient age was 59 [43;65] years, the median GCS score was 3 [3;3], and the median FOUR score was 0 [0;0]. Median hospital length of stay was 1.5 [1;2.5] days, and median intensive care unit (ICU) stay was 1 [1;2] day.Conclusion: Insufficient pupil diameter (<5 mm) is a limiting factor for the performance of BDD procedures in grade III coma patients.