From the Guidelines
Pronouncing someone dead requires the cessation of circulation and respiratory function for at least 2 minutes, as stated in the American Thoracic Society guidelines 1. The process of determining death involves a series of clinical evaluations to confirm the absence of vital signs.
Key Criteria for Pronouncing Death
- Absence of pulse at major arteries (carotid or femoral)
- Absence of breathing for at least 2 minutes, as per the American Thoracic Society guidelines 1
- Fixed, dilated pupils that don't respond to light Additional confirmation may include:
- Using a stethoscope to listen for heart sounds
- Checking for response to painful stimuli
- Observing for lividity (blood pooling) or rigor mortis in later stages In some jurisdictions, an ECG showing asystole (flatline) for a specified period may be required.
Brain Death Criteria
For brain death, the diagnosis relies on a clinical diagnosis based on the absence of neurologic function with a known irreversible cause of coma, as stated in the American Academy of Pediatrics guidelines 1. The criteria for brain death include:
- Two examinations, including apnea testing, separated by an observation period
- The examinations should be performed by different attending physicians
- Apnea testing must be performed safely, with documentation of an arterial PaCO2 20 mm Hg above the baseline PaCO2 and ≥ 60 mm Hg with no respiratory effort during the testing period
Declaration of Death
Death is declared after confirmation and completion of the second clinical examination and apnea test, or after ancillary studies have been performed, as stated in the American Academy of Pediatrics guidelines 1. The time of death is recorded at the moment the healthcare provider makes this determination, not necessarily when biological death occurred. It is essential to note that the determination of death should be made by experienced clinicians who are familiar with the patient population and have specific training in critical care, as stated in the American Academy of Pediatrics guidelines 1.
From the Research
Criteria for Pronouncing Someone Deceased
The criteria for pronouncing someone deceased are not explicitly stated in the provided studies. However, some studies provide information on the assessment and diagnosis of patients who are deteriorating or have suffered cardiopulmonary arrest.
Assessment and Diagnosis
- The ABCDE approach is used to assess deteriorating patients, which includes checking the patient's airway, breathing, circulation, disability, and exposure 2.
- The ABC sequence (airway-breathing-circulation) is used in resuscitation guidelines, while the CAB sequence (circulation-airway-breathing) has been used in the past 3, 4.
- Pulse checks are an important part of cardiopulmonary resuscitation, and the carotid artery is recommended as the gold standard localization for pulse checks due to its higher sensitivity compared to the femoral artery 5.
Differential Diagnosis
- Differential diagnosis is a systematic process used to identify the proper diagnosis from a set of possible competing diagnoses 6.
- The diagnostic process involves identifying or determining the etiology of a disease or condition through evaluation of patient history, physical examination, and review of laboratory data or diagnostic imaging 6.
Resuscitation Guidelines
- The Netherlands Resuscitation Council has revised its resuscitation guidelines to conform with the international guidelines, which use the ABC sequence 3, 4.
- The use of the ABC or CAB sequence in resuscitation guidelines is based on various arguments, including time-saving, improvement of ventilation-perfusion ratio, and oxygenation of the blood in the lung capillaries 4.