What is a brain death examination?

From the Guidelines

Brain Death Examination

A brain death examination is a clinical diagnosis that requires evidence of absent brain and brainstem function, typically determined through a physical examination, which includes unreceptivity and unresponsivity, no movements or breathing, no reflexes, and a flat electroencephalogram tracing 1.

Key Components

• The examination must be performed with precision and in accordance with accepted medical standards, as outlined in the Uniform Determination of Death Act 1.
• The presence of certain medications, such as neuromuscular blocking agents (NMBAs), can prevent accurate assessment of the physical examination-based criteria for determining brain death, and their use during a brain death examination is not justified unless the patient has a train-of-four (TOF) of 4/4 as measured using peripheral nerve stimulation (PNS) at the maximum current 1.
• Other means of determining brain death, such as electroencephalogram, transcranial Doppler, or cerebral perfusion scans, have not been recommended as a replacement for the clinical brain death examination, but may be used as a surrogate in cases where the clinical determination cannot be made, such as when an accurate clinical examination is hampered by the presence of hypnotics or sedatives 1.

Clinical Diagnosis

The clinical diagnosis of brain death requires a thorough physical examination, which includes assessing the patient's level of consciousness, brainstem reflexes, and respiratory function, and is typically performed by a qualified healthcare professional, such as a neurologist or intensivist 1.

• The examination should include a series of tests, such as the apnea test, to determine if the patient has lost all brain function, including the brainstem 1.
• The use of ultrasound or other imaging modalities may be useful in supporting the clinical diagnosis of brain death, but is not a replacement for the physical examination 1.

From the Research

Brain Death Examination

A brain death examination is a clinical evaluation used to determine if a person has suffered irreversible loss of all brain function, including the brainstem [ 2 ]. The examination involves a series of tests and assessments to confirm the absence of brain activity.

Clinical Components of the Brain Death Exam

The main clinical components of the brain death exam include:

• Assessment of coma [ 3 ]
• Cranial nerves examination [ 2 ]
• Motor testing [ 2 ]
• Apnea testing [ 2 ]

Ancillary Tests

In some cases, ancillary tests may be used to support the diagnosis of brain death, including:

• Electroencephalogram (EEG) [ 4 ]
• Catheter cerebral angiogram [ 4 ]
• Transcranial Doppler [ 4 ]
• Nuclear scintigraphy [ 4 ]

Determination of Brain Death

The determination of brain death involves a combination of clinical evaluation and ancillary tests [ 5 ]. The diagnosis of brain death is made when there is a persistent coma, absent brainstem reflexes, and no spontaneous respiratory effort [ 5 ].

Process for Brain Death Certification

The process for brain death certification involves several steps, including:

• Identification of the cause of brain dysfunction [ 6 ]
• Exclusion of any condition that might confound the examination [ 6 ]
• Performance of a complete neurological examination [ 6 ]
• Assessment of brainstem reflexes [ 6 ]
• Clinical observations compatible with the diagnosis of brain death [ 6 ]