Background: Brain death is the irreversible cessation of the function of the brain including the brainstem. In 2013, the Brain Injury Evaluation Quality Control Centre (BQCC) of the National Health and Family Planning Commission issued criteria and practical guidelines for the determination of brain death. This study aimed to evaluate whether the institutions have adopted these guidelines and to make suggestions for the improvement of the current criteria and practical guidelines for brain death determination in China.
Methods: Consecutive brain death cases from 44 hospitals were evaluated for summary statistics for the following data: the performance of BQCC criteria and practical guidelines, clinical examination, apnea testing, ancillary testing, and the number of examinations as well as the waiting periods between examinations and details of who determined brain death. Data analysis was conducted from January 2013 to December 2017.
Results: A total of 550 cases were obtained. All patients were determined to have deep coma and met the prerequisites for clinical testing. The performance rates of four brainstem reflex examinations (except cough reflex) ranged from 97.5% to 98.0%, and the completion rate as well as the coincidence rate were both 100.0%. The 238 cases (50.7%) completed apnea testing, and 231 cases (42.0%) had to stop apnea testing during the examination because of instability. The performance rates of the three ancillary tests, including electroencephalogram, short-latency somatosensory evoked potential, and transcranial Doppler, were 89.5%, 67.5%, and 79.5%, respectively; furthermore, the coincidence rates were 98.6%, 96.5%, and 99.5%, respectively. The combination of two ancillary tests was more accurate than one single ancillary test. A total of 401 (72.9%) cases successfully underwent two separate examinations to determine brain death with at least a 12-h waiting period. All brain death cases were determined by at least two qualified physicians.
Conclusion: This study might provide suggestions for brain death determination in China.
中国脑死亡判定调查与改进建议 摘要 背景：脑死亡是大脑功能的不可逆转的停止，包括脑干。2013年，国家卫生和计划生育委员会脑损伤评估质量控制中心（BQCC）发布了确定脑死亡的标准和实用指南。本研究旨在评估机构是否已采纳这些指导方针，并为改进我国现行的脑死亡判定标准和实用指导方针提出建议。 方法：对44家医院连续发生的脑死亡病例进行总结性统计，包括BQCC标准和实用指南的执行情况、临床检查、呼吸暂停试验、辅助检查、检查次数以及检查之间的等待时间。世卫组织确定脑死亡的检查和细节。资料分析于2013年1月至2017年12月进行。 结果：共获得550例患者。所有患者均确诊为深昏迷，符合临床试验的先决条件。脑干反射检查 (除咳嗽反射外) 完成率97.5-98.0%,符合率100.0%。约238例（50.7%）患者完成呼吸暂停试验，231例（42.0%）患者因检查不稳定而不得不停止呼吸暂停试验。脑电图（EEG）、短潜伏期体感诱发电位（SLSEP）、经颅多普勒（TCD）三项辅助检查的检出率分别为89.5%、67.5%和79.5%，符合率分别为98.6%、96.5%和99.5%。两个辅助测试的组合比一个单一的辅助测试更准确。总共有401例（72.9%）患者在至少12小时的等待期内成功地进行了两次独立的检查以确定脑死亡。所有脑死亡病例由至少两名合格的医师确定。 结论：本研究为中国脑死亡测定指南的更新和完善提供了依据。.
Keywords: Ancillary Tests; Apnea Testing; Brain Death.