Brain death

Abstract

Declaration of brain death requires demonstration of irreversible injury to the whole brain including the brainstem. Current guidelines rely on bedside clinical examination to determine that the patient has irreversible coma, absent cranial nerve reflexes, and apnea. Neurophysiologic testing to support the clinical diagnosis of brain death has primarily consisted of EEG and evoked potentials-typically a combination of somatosensory evoked potential and brainstem auditory evoked potential. The diagnostic accuracy of these ancillary tests has been studied for the last few decades but the role of ancillary neurophysiologic testing in brain death continues to be a source of controversy. This chapter reviews the relevant studies and guidelines about EEG and evoked potentials in ancillary testing for brain death. Clinical scenarios in which neurophysiologic testing may aid the declaration of brain death include equivocal results of clinical examination findings, inability to perform some aspects of the neurologic examination, concern for residual sedative effects, suspected spinal cord or neuromuscular injury, and posterior fossa lesions with brainstem involvement. In these scenarios, EEG and evoked potentials may offer supportive evidence for irreversible injury to the whole brain. This chapter also discusses differences between current adult and pediatric guidelines for the role of ancillary testing in brain death.

Keywords: Brain death; Electroencephalography; Evoked potentials; Guidelines; Neurophysiology; Pediatrics.