The AAP and three other medical societies have issued new guidance for clinicians on the determination of brain death in children and adults.
The AAP, American Academy of Neurology (AAN), Child Neurology Society (CNS) and Society of Critical Care Medicine (SCCM) released 85 recommendations, updating the 2011 pediatric guidance from the AAP-CNS-SCCM (AAP clinical report, https://bit.ly/48ySl3n) and 2010 adult guidance from the AAN.
The new guidance Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Guideline is available at https://bit.ly/3F1B9pD and will be published in the Dec. 12 issue of Neurology.
Brain death, or death by neurological criteria, is different from comatose and vegetative states. Brain death is declared if a person has a catastrophic injury, has no possibility of recovering any brain function, is completely unresponsive, does not demonstrate any brain or brainstem function and does not breathe on his or her own.
“Any child’s death is never short of devastating,” said Sonia Partap, M.D., M.S., FAAP, a guideline co-author. “Pediatricians share a special relationship and trust with their patients, and this guideline is to ensure we help families walk through the most difficult circumstances,” said Dr. Partap, a clinical professor of neurology and pediatrics at Stanford University in California.
Experts from academic and community settings developed the guidance based on an evidence-informed consensus process. The guideline offers a standardized procedure that covers the prerequisites for brain death determination, the examination and the examiners, apnea testing and ancillary testing.
While the core components are similar to previous guidance, there are updates on issues related to determination of death by neurologic criteria in the setting of extracorporeal membrane oxygenation, targeted temperature management and primary infratentorial injury.
Key aspects of the guidance include the following:
- Catastrophic, irreversible brain injury must be established before evaluation can begin.
- Confounding effects of metabolic abnormalities or intoxication must be addressed prior to evaluation.
- The guidance recommends acceptable ancillary tests for brain death determination when needed.
Brain death determination policies vary among hospitals, so hospital leaders should ensure that their policies are consistent with this new guideline, according to an AAN news release.
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