December 2002, Volume 32 Number 12 , p 68 - 69
Outline Clinical examination criteria
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SINCE ANCIENT TIMES, death was believed to occur when heart and lung function stopped. Now that technology can maintain these functions artificially, death by neurologic criteriabrain death, or the cessation of both cerebral and brain stem functionhas become an accepted declaration of death.
In 1995, the Quality Standard Subcommittee of the American Academy of Neurology (AAN) published adult practice parameters for determining brain death that hospitals in the United States have used to develop institutional brain death protocols. (See Defining Death for other recent precedents for brain death criteria.) The AAN recommendations include:
* demonstration of coma
* evidence for cause of coma
* absence of other, potentially reversible medical conditions that could cause coma, such as hypo-thermia, drug overdose, and electrolyte or endocrine disturbances
* absence of brain stem reflexes
* absence of motor responses
A repeat evaluation in 6 hours is advised, although the time frame is flexible and no national standard exists at present. Some facilities require two separate clinical examinations at 2- to 6-hour intervals. At our hospital, a different physician can perform the second exam immediately after the first.
Lab tests may also be required to confirm findings that can't be reliably determined via clinical examination. Some states designate certain medical specialists, such as neurologists, to declare brain death.
Clinical examination criteria
The clinical examination for brain death establishes the absence of cerebral and brain stem functions. Many hospitals use a form for brain death certification that's the equivalent to a traditional pronouncement ...