Pediatric Brain Death.

Abstract

1. Brooke T. McLaughlin, MD, MPH* 2. James J. Filiano, MD* 1. *Dartmouth Hitchcock Medical Center, Lebanon, NH A 3-year-old boy was airlifted from a nearby hospital after a motor vehicle collision. At the scene he had a prolonged extraction and was not breathing. He was intubated and experienced cardiac arrest during transport. Cardiopulmonary resuscitation was performed, with return of circulation. On arrival at the emergency department the patient exhibited complete loss of consciousness, vocalization, and volitional and reflex activity. Computed tomographic scans consistent with global cerebral infarction and laboratory results of multiorgan failure indicated little hope for meaningful recovery. The team waited 24 hours from the time of injury and prepared to initiate the brain death examination. The family was despondent and refused to believe that the damage could be irreversible. The team called the chaplain, social worker, and primary care physician to support the family in the subsequent hours. The initial brain death examination found the child unresponsive to painful stimuli, with fixed pupils and absent light, corneal, cough, gag, and oculovestibular reflexes. An apnea test demonstrated no spontaneous respiratory effort to PaCO2 greater than 60 mm Hg. A post–24-hour examination and apnea test confirmed that the child fulfilled the criteria for brain death. The family struggled to accept the news because their child appeared alive to them: his heart was beating and his chest was rising on the mechanical ventilator. Brain death is a legal definition of death recognized in every state in the United States. It is the irreversible cessation of all function of the entire brain, including the brain stem. There is medical, legal, and social consensus that loss of this function equates to death just as definitively as irreversible cessation of circulatory and respiratory function. However, it remains a challenging issue because brain-dead patients often maintain the appearance of life while on a ventilator (or while receiving other assisted support). This …