Canadian Journal of Anesthesia

, Volume 53, Issue 6, pp 620–627 | Cite as

Brief review: The role of ancillary tests in the neurological determination of death

  • G. Bryan Young
  • Sam D. Shemie
  • Christopher James Doig
  • Jeannie Teitelbaum
Article

Abstract

Purpose

The acceptance of brain death by society has allowed for the discontinuation of “life support” and the transplantation of organs. In Canada we accept the clinical criteria for brain death (essentially brain stem death) when they can be legitimately applied. Ancillary tests are needed when these clinical criteria cannot be applied or when there are confounders. Ancillary tests include tests of intracranial blood circulation, electrophysiological tests, metabolic studies and tests for residual vagus nerve function. The ideal confirmatory test is one which, when positive, would be incompatible with recoverable brain function (i.e., has no false positives), is not influenced by drugs or metabolic disturbances and which can be readily applied. A critical review of the various ancillary tests used to support the neurological determination of death (brain death) was undertaken.

Methods

A literature review based on a MEDLINE search of relevant articles published between January 1966 to January 2005 was undertaken.

Results

Tests of whole brain perfusion/intracranial blood circulation are the only ones that meet stated criteria.

Conclusions

At present only cerebral angiography and nuclear medicine tests of perfusion are accepted by Canadian standards, but computed tomography and magnetic resonance angiography should prove to be suitable. Transcranial Doppler studies may be suitable for specific cases once appropriate guidelines are established.

Keywords

Single Photon Emission Compute Tomography Brain Death Neurological Determination Jugular Bulb Brain Blood Flow 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Revue sommaire : le rôle des tests accessoires dans la détermination neurologique de la mort

Résumé

Objectif

Ľacceptation de la mort encéphalique par la société a permis ľinterruption du «maintien des fonctions vitales» et la transplantation ďorganes. Au Canada, nous acceptons les critères cliniques de la mort encéphalique (essentiellement, mort du tronc cérébral) quand ils peuvent légitimement s’appliquer. Des tests auxiliaires sont nécessaires quand ces critères ne peuvent être appliqués ou quand ils sont confondants. Ils comprennent les tests de circulation sanguine intracrânienne, les épreuves électrophysiologiques, les études métaboliques et les tests de fonction résiduelle du nerf vague. Le test de confirmation idéal est celui qui, s’il est positif, est incompatible avec une récupération de la fonction cérébrale (donc, sans faux positifs), n’est pas modifié par les médicaments ou les désordres métaboliques et peut être facilement réalisé. Nous avons fait une revue critique des différents tests accessoires utilisés lors de la détermination neurologique de la mort (mort encéphalique).

Méthode

Nous avons recherché les articles pertinents de MEDLINE publiés entre janvier 1966 et janvier 2005.

Résultats

Les tests de perfusion cérébrale totale/de circulation sanguine intracrânienne sont les seuls qui répondent aux critères convenus.

Conclusion

À présent, les seuls tests acceptés par les normes canadiennes sont ľangiographie cérébrale et les tests de perfusion de la médecine nucléaire. La tomodensitométrie et ľangiographie par résonance magnétique devraient se révéler appropriés. Dans des cas spécifiques, les examens de doppler transcrânien peuvent convenir une fois établies les directives appropriées.

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Copyright information

© Canadian Anesthesiologists 2006

Authors and Affiliations

  • G. Bryan Young
    • 1
  • Sam D. Shemie
    • 2
  • Christopher James Doig
    • 3
  • Jeannie Teitelbaum
    • 4
  1. 1.Department of Clinical Neurological SciencesLondon Health Sciences Centre, University of Western OntarioLondonCanada
  2. 2.Division of Pediatric CareMontreal Children’s Hospital, McGill University Health Centre, Montreal
  3. 3.Adult Critical CareUniversity of CalgaryAlberta
  4. 4.Division of NeurologyMontreal Neurological Institute, MontrealCanada

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