Spontaneous and Reflex Movements of the Brain Death in South-East Province of South Korea

Abstract

Introduction During the diagnosis of the brain death, remained spontaneous or reflex movements of the patient may cause confusion of status of brain death and many medical staffs are reluctant to diagnose the brain death. In order to analyze multiple movements of brain death patients and provide the helpful basis for diagnosis of brain death, we reviewed our video record checked during patient management. Methods We conducted a regional cohort study of adult patients (≥aged 19 years old) with brain death admitted to the hospital care systems in south-east province of South Korea from January 2013 to December 2016. We divide the patients into two groups: ‘Brain death with spontaneous and reflex movements’ and ‘Brain death without spontaneous and reflex movements’. We described the patterns of spontaneous and reflex movements through video analysis. Demographic and clinical characteristics including the causes of brain death, timing of spontaneous and reflex movement detection, hemodynamic parameters, and arterial blood gas findings were compared between the two groups. Results During the study period, 436 patients met criteria for brain death. Among them, 74 (17.0%, age 49.7±12.6 years, 64.9% males) subjects had spontaneous or reflex movements, which were analyzed in the way of video record. The most common movements were the extensor plantar response and tonic neck reflex. The logistic regression analysis revealed that hypoxic brain injury (OR=2.93, p=0.001), higher mean systolic blood pressure (OR=1.05, p=0.000), and longer the time from diagnosis of brain death (OR=1.04, p=0.016) were significantly correlated with presence of spontaneous or reflex movement in brain death subjects. There were no statistically significant differences in age, sex, height, heart rate, body temperature, blood PH, bicarbonate and partial pressure of oxygen and carbon dioxide levels. Conclusions While diagnosing a brain death especially caused by hypoxic brain injury, higher mean systolic pressure, and longer time from diagnosis of brain death, special attention is necessary not to exclude brain death in such patients with spontaneous and reflex movements. The common movements that appeared on video review were extensor plantar response and tonic neck reflex. As we know through the above results, medical staffs who perform the diagnosis of the brain death need opportunities for sharing diverse experiences and information.