The EEG in the Determination of Brain Death in Pediatric Patients The NIH Study

  • Donald R. Bennett


The National Institute of Health Collaborative Study of Cerebral Survival (CS) remains the largest prospective study on the outcome of patients with cerebral unresponsivity and apnea. One purpose of this investigation was to formulate a set of criteria that would identify a dead brain in an otherwise living body. Although patients under 1 year of age were excluded and only 43 of the 503 patients enrolled were between the ages of 1 and 9 years, the electroencephalographic (EEG) results of this study are relevant to the pediatric brain-death issue. Therefore, the EEG experiences and findings are reviewed and correlated with clinical data as well as with other investigations. Where potential problems or differences in the pediatric age group are seen, they are so commented on. Since the CS report was published, it has been criticized, and some of the criticisms are justified, particularly the working definition of apnea. However, the CS study serves as a prototype for future investigations.


Sudden Infant Death Syndrome Pediatric Intensive Care Unit Brain Death Interelectrode Distance Brainstem Reflex 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. An Appraisal of the Criteria of Cerebral Death, 1977, A Summary Statement. JAMA, 237: 982–986.CrossRefGoogle Scholar
  2. Bennett, D. R., 1978, The EEG in the determination of brain death, Ann. NY Acad. Sci. 315: 110–120.PubMedCrossRefGoogle Scholar
  3. Bennett, D. R., 1981, Brain death. (Letter.) Lancet. 1: 106.CrossRefGoogle Scholar
  4. Bennett, D. R., Hughes, J. R., Korein, J., Merlis, J. K., Suter, C., 1976, Atlas of Electroencephalography in Coma and Cerebral Death, Raven, New York.Google Scholar
  5. Chatrian, G. E., 1986, Electrophysiologic evaluation of brain death: A critical appraisal, in: Electrodiagnosis in Clinical Neurology, M. J. Aminoff, (ed.), Underhill, Livingston, New York.Google Scholar
  6. Coulter, D. L., 1987, Neurologic uncertainty in newborn intensive care, N. Engl. J. Med. 316: 840–844.PubMedCrossRefGoogle Scholar
  7. Drake, B., Ashwal, S., and Schneider, S., 1986, Determination of cerebral death in the pediatric intensive care unit, Pediatrics 78: 107–112.PubMedGoogle Scholar
  8. Fishgold, H., and Mathis, P., 1959, Obnubilations, Comas et stupeurs. Electroencephalogr. Clin. Neurophysiol. Suppl. 11: 1–124.Google Scholar
  9. Fletcher, C. M., 1982, The clinical diagnosis of pulmonary emphysema—An experimental study, Proc. R. Soc. Med. 45: 577–584.Google Scholar
  10. Furgivele, T. L., Frank, M., Riegle, C., Wirth, F., and Earley, L. C., 1984, Prediction of cerebral death by cranial sector scan, Crit. Care Med. 12: 1–3.CrossRefGoogle Scholar
  11. Guidelines for the Determination of Brain Death in Children, 1987, Neurology (NY) 37:1077–1078.Google Scholar
  12. Guidelines for the Determination of Death, 1981, JAMA 246: 2184–2186.CrossRefGoogle Scholar
  13. Holzman, B. H., Curless, R. G., Sfakianakio, G. N., Ajmone-Marsan, C., and Montes, J. E., 1983, Radionuclide cerebral perfusion scintigraphy in determination of brain death in children, Neurology (NY) 33: 1027–1031.Google Scholar
  14. The International Federation of Societies for Electroencephaloghraphy and Clinical Neurophysiology, 1983, EEG Instrumentation Standards, (rev. 1977 ). Report of the Committee on EEG Instrumentation Standards of the International Federation Societies for Electroencephalography and Clinical Neurophysiology, Elsevier, Amsterdam.Google Scholar
  15. Minimum Technical Standards for EEG Recordings in Suspected Cerebral Death, 1986, J. Clin. Neurophysiol. 3: 144–149.CrossRefGoogle Scholar
  16. Mollaret, P., and Goulon, M., 1959, Le coma dépassé (mémoire préliminaire), Rev. Neurol. 101: 3–I5.PubMedGoogle Scholar
  17. Moshe, S. L., and Alvarez, L. A., 1986, Diagnosis of brain death in children, Jo. Clin. Neurophysiol. 3: 239–249.CrossRefGoogle Scholar
  18. Pallis, C., and MacGillivray, B., 1980, Brain death in the EEG. (Letter.) Lancet 2: 1085.CrossRefGoogle Scholar
  19. Pampiglione, G., Chaloner, J., Harden, A., and O’Brien, J., 1978, Transitory ischemia/anoxia in young children and the prediction of quality of survival, Ann. NY Acad. Sci. 315: 281–292.PubMedCrossRefGoogle Scholar
  20. Pollack, M. A., and Kelleway, P., 1978, Cortical death with preservation of brainstem function. Correlation of clinical, electrophysiologic and CT scan findings in 3 infants and 2 adults with prolonged survival, Trans. Am. Neurol. Assoc. 103: 36–38.PubMedGoogle Scholar
  21. Prior, P. F., 1973, The EEG in Acute Cerebral Anoxia, Excerpta Medica. Amsterdam.Google Scholar
  22. Rowland, T. W., Donnelly, J. H., Jackson, A. H., and Jamroz, S. B., 1983, Brain death in the pediatric intensive care unit, Am. J. Dis. Child. 137: 547–550.PubMedGoogle Scholar
  23. Schwartz, J. A., Baxter, J., Brill, D., and Burns, J. R., 1983, Radionuclide cerebral imaging confirming brain death, JAMA 249: 246–247.PubMedCrossRefGoogle Scholar
  24. Television verdict on brain death. (Editorial.), 1980, Lancet 2: 841.Google Scholar
  25. Van Den Berge, J. H., Schouten, H. J. A., Boomstra, S., Van Drunnen Little, S., and Braakman, R., 1979, Interobserver agreement in assessment of ocular signs in coma, J. Neurol. Neurosurg. Psychiatry 42: 1163–1168.PubMedCrossRefGoogle Scholar
  26. Walker, A. E., Diamond, E. L., and Moseley, J. I., 1975, The neuropathological findings in irreversible coma. A critique of the “respirator brain,” J. Neuropathol. Exp. Neurol. 34: 296–323.CrossRefGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1989

Authors and Affiliations

  • Donald R. Bennett
    • 1
    • 2
  1. 1.Department of NeurologyUniversity of Nebraska College of MedicineOmahaUSA
  2. 2.Department of NeurologyCreighton University School of MedicineOmahaUSA

Personalised recommendations