From the Guidelines
Gurd's criteria for determining brain death include a set of specific clinical assessments to confirm the irreversible cessation of brain function, requiring a deep coma, absence of brainstem reflexes, and absence of spontaneous respiration, with exclusion of confounding factors such as hypothermia, drug intoxication, metabolic disturbances, or neuromuscular blocking agents, as outlined in the 2011 guidelines for the determination of brain death in infants and children 1.
Key Components of Gurd's Criteria
- Deep coma with no response to painful stimuli
- Absence of brainstem reflexes, including:
- Pupillary reflexes
- Corneal reflexes
- Oculocephalic reflexes
- Oculovestibular reflexes
- Gag reflexes
- Absence of spontaneous respiration as confirmed by an apnea test, with a PaCO2 level above 60 mmHg and at least 20 mmHg above the baseline level 1
- Exclusion of confounding factors, such as:
- Hypothermia (body temperature must be above 32°C)
- Drug intoxication
- Metabolic disturbances
- Neuromuscular blocking agents
Clinical Examination and Apnea Testing
- Two separate examinations, typically performed 6-24 hours apart by different physicians, are required to confirm brain death 1
- Apnea testing must be performed safely and requires documentation of an arterial PaCO2 level above 60 mmHg and at least 20 mmHg above the baseline level, with no respiratory effort during the testing period 1
Ancillary Studies
- Additional confirmatory tests, such as electroencephalography (EEG), cerebral angiography, or transcranial Doppler ultrasonography, may be used in situations where clinical examination is limited 1
- These studies are not required to establish brain death but can be used to assist in making the diagnosis, particularly when components of the examination or apnea testing cannot be completed safely 1
From the Research
Gurd's Criteria for Determining Brain Death
There is no direct mention of Gurd's criteria in the provided studies. However, the studies do discuss the criteria for determining brain death, which may be relevant to the topic.
Criteria for Brain Death
The criteria for brain death include:
- Coma [(2,3,4,5)]
- Absence of brainstem reflexes [(2,3,4,5)]
- Loss of central drive to breathe, assessed with an apnea test [(2,3,5)]
- Exclusion of confounders, such as hypothermia or central nervous system depressants [(3,5)]
- Determination of futility of medical or surgical intervention 2
Clinical Evaluation
The clinical evaluation for brain death requires a comprehensive assessment, including:
- Examination of brainstem reflexes [(2,3,4)]
- Apnea testing [(2,3,5)]
- Electroencephalogram (EEG) 5
- Exclusion of confounders [(3,5)]
Ancillary Tests
Ancillary tests, such as imaging studies, may be used to support the diagnosis of brain death, especially in situations where clinical testing cannot be performed or is uncertain 3. These tests include: