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The observation period after clinical brain death diagnosis according to ancillary tests: differences between supratentorial and infratentorial brain injury

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Abstract

Objective

To determine the optimal observation period (OBP) in adults with a clinical diagnosis of brain death (BD) using electroencephalography (EEG) or computerized tomography angiography (CTA).

Methods

We conducted a retrospective observational analysis of adult patients with a diagnosis of BD from January 2000 to February 2017. The optimal OBP was defined as the minimum time interval from the first complete clinical neurological examination (CNE) that ensures that neither a second CNE nor any ancillary test (AT) performed after this period would fail to confirm BD.

Results

The study sample included 447 patients. In the supratentorial group, the first AT confirmed BD in 389 cases (98%), but in 8 (2%) cases the complementary test was incongruent. In this group, 8 of 245 patients in whom the first AT was carried out within the first 2 h after a complete CNE had a non-confirmatory test of BD versus none of 152 in whom the first AT was delayed more than 2 h (3.0% vs 0.0%; p = 0.026). In the infratentorial group, we found a higher probability of obtaining a first non-confirmatory AT of BD (34% vs 2%; p = 0.0001) and an OBP greater than 32.5 h was necessary to confirm a BD diagnosis.

Conclusions

We found important differences in the confirmation of BD diagnosis between primary supratentorial and infratentorial lesion, and identified an optimal OBP of 2 h in patients with supratentorial lesions. By contrast, in primary posterior fossa/infratentorial lesions, the determination of an optimal OPB remains less accurate and hence more challenging.

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Acknowledgements

The authors are indebted with Professor Peter W. Kaplan (Baltitmore, USA) by his kind revision of the manuscript and invaluable comments and suggestions.

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Authors and Affiliations

  1. Neurocritical Care Unit, Department of Intensive Medicine, Marqués de Valdecilla University Hospital, Avda Valdecilla no. 25, 39008, Santander, Cantabria, Spain

    Miguel Ángel Hernández-Hernández

  2. Department of Radiology, Marqués de Valdecilla University Hospital, Santander, Spain

    Enrique Marco de Lucas

  3. Intensive Care Unit, Clínica Rotger, Grupo Quirón, Palma de Mallorca, Baleares, Spain

    Cristina Muñoz-Esteban

  4. Department of Internal Medicine, Marqués de Valdecilla University Hospital, University of Cantabria, Santander, Spain

    José Luis Hernández

  5. Department of Clinical Neurophysiology, Marqués de Valdecilla University Hospital, Santander, Spain

    José Luis Fernández-Torre

  6. Department of Physiology and Pharmacology, University of Cantabria (UNICAN), Santander, Spain

    José Luis Fernández-Torre

  7. Biomedical Research Institute (IDIVAL), Santander, Spain

    Miguel Ángel Hernández-Hernández, Enrique Marco de Lucas, José Luis Hernández & José Luis Fernández-Torre

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  1. Miguel Ángel Hernández-Hernández
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  2. Enrique Marco de Lucas
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  3. Cristina Muñoz-Esteban
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  4. José Luis Hernández
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  5. José Luis Fernández-Torre
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Corresponding author

Correspondence to Miguel Ángel Hernández-Hernández.

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The authors declare that this research has been approved by the appropriate ethics committee and has, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Spanish laws have been observed, too.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Hernández-Hernández, M.Á., Marco de Lucas, E., Muñoz-Esteban, C. et al. The observation period after clinical brain death diagnosis according to ancillary tests: differences between supratentorial and infratentorial brain injury. J Neurol 266, 1859–1868 (2019). https://doi.org/10.1007/s00415-019-09338-5

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  • DOI: https://doi.org/10.1007/s00415-019-09338-5

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