Critical Matters Death By Neurologic Criteria
Nov 12, 2020
In this discussion, Dr. David Greer, Chair of Neurology at Boston University, delves into the complexities of brain death and the World Brain Death Project. He emphasizes the importance of conservative diagnostic criteria to prevent misdiagnosis. Greer explains necessary prerequisites for brain death testing, the significance of the apnea test, and the role of ancillary testing. He also highlights the ethical challenges families face and the need for precise documentation in declaring time of death, ensuring clarity and trust in critical care.
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No Mandatory Delay Between Exams
- There's no logical need to delay a second exam after prerequisites are met; further waiting implies the first exam was premature.
- Time separation is logistical, not clinical.
Use Ancillary Tests Only When Necessary
- Reserve ancillary tests for when you cannot complete or trust the clinical exam; never substitute them for a thorough bedside exam.
- Do the clinical exam fully before ordering flow or electrical studies.
Choose Flow Studies Over EEG
- Prefer flow studies for ancillary testing: digital subtraction angiography (gold standard), SPECT with lipophilic tracers, or transcranial Doppler with reverberating flow patterns.
- Avoid EEG as it doesn't assess brainstem and is unreliable for brain death.
