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Revised Brain Death Criteria

Revised Brain Death Criteria - Evidence-based guideline...

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DOI 10.1212/WNL.0b013e3181e242a8 2010;74;1911 Neurology Eelco F.M. Wijdicks, Panayiotis N. Varelas, Gary S. Gronseth, et al. American Academy of Neurology adults : Report of the Quality Standards Subcommittee of the Evidence-based guideline update: Determining brain death in August 11, 2011 This information is current as of http://www.neurology.org/content/74/23/1911.full.html located on the World Wide Web at: The online version of this article, along with updated information and services, is rights reserved. Print ISSN: 0028-3878. Online ISSN: 1526-632X. All since 1951, it is now a weekly with 48 issues per year. Copyright © 2010 by AAN Enterprises, Inc. ® is the official journal of the American Academy of Neurology. Published continuously Neurology by guest on August 11, 2011 www.neurology.org Downloaded from
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Evidence-based guideline update: Determining brain death in adults Report of the Quality Standards Subcommittee of the American Academy of Neurology Eelco F.M. Wijdicks, MD, PhD Panayiotis N. Varelas, MD, PhD Gary S. Gronseth, MD David M. Greer, MD, MA ABSTRACT Objective: To provide an update of the 1995 American Academy of Neurology guideline with regard to the following questions: Are there patients who fulfill the clinical criteria of brain death who recover neurologic function? What is an adequate observation period to ensure that cessation of neurologic function is permanent? Are complex motor movements that falsely suggest retained brain function sometimes observed in brain death? What is the comparative safety of techniques for determining apnea? Are there new ancillary tests that accurately identify patients with brain death? Methods: A systematic literature search was conducted and included a review of MEDLINE and EMBASE from January 1996 to May 2009. Studies were limited to adults (aged 18 years and older). Results and recommendations: In adults, there are no published reports of recovery of neurologic function after a diagnosis of brain death using the criteria reviewed in the 1995 American Acad- emy of Neurology practice parameter. Complex-spontaneous motor movements and false- positive triggering of the ventilator may occur in patients who are brain dead. There is insufficient evidence to determine the minimally acceptable observation period to ensure that neurologic functions have ceased irreversibly. Apneic oxygenation diffusion to determine apnea is safe, but there is insufficient evidence to determine the comparative safety of techniques used for apnea testing. There is insufficient evidence to determine if newer ancillary tests accurately confirm the cessation of function of the entire brain. Neurology ® 2010;74:1911–1918 GLOSSARY AAN American Academy of Neurology; CI confidence interval; CPAP continuous positive airway pressure; CTA CT angiography; HMPAO Tc 99mHexametazime; MRA magnetic resonance angiography; PEEP positive end-expiratory pressure; SSEP somatosensory evoked potential; TCD transcranial Doppler; UDDA Uniform Determination of Death Act.
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