Brain death

Criteria

1. Known proximate cause of condition
2. Exclusion of complicating medical conditions (severe electrolyte, acidbase, or endocrine disturbance)
3. No drug intoxication/poisoning
4. Core temp >32C (90F)
5. Cerebral unresponsiveness
6. Absence of brain stem relexes (see below)
7. Apneic (see below)
8. Irreversible condition (+/- repeat exam in 6hrs)

Brain Stem Reflexes

1. Pupils
   1. no response to light (fixed and mid-dialated)
2. Ocular movement
   1. no oculocephalic reflex (+Doll's Eyes)
   2. no vestibulocochlear (deviation of eyes to irrigation w/ 50mL cold water to ears - allow 1 min after and 5 min b/t)
3. Facial motor response/sensation
   1. jaw reflex (grimacing to deep facial pressure)
   2. corneal reflex (touch eye w/ swab)
4. Paryngeal/tracheal
   1. gag (tounge blade)

Apnea Testing

1. Prerequisites:
   1. Clinical Criteria
   2. Core temp >32 C (actual temp value > 32 varies by institution) with corrected electrolytes. > 36.5C is preferred.
   3. SBP >90
   4. Nl PCO2 (>40)
   5. Nl PO2 (preoxiginate >200)
2. Test:
   1. check baseline ABG (ensure PCO2 <40mmHg to maximate target PCO2 rise)
   2. Connect pulse ox, disconnect ventilator, place nasal cannula in ET (at carina), and place on 100% O2 @ 6LPM.
   3. Physician able to declare brain death (typically neurology/neurosurgery) will observe for resp movements
   4. Draw ABG @ 8 min. Observe for PCO2 rise >20mmHg over 8 minutes with no respiratory movement -->positive apnea test (supports brain death)
      1. Pos test = 20 increase over baseline (typically 60) ensure to blow down CO2 to ~40 to enable 20mmHg rise. Typical rise is 3mmHg per minute
3. Considerations
   1. Abort the test (reconnect ventilator) if SBP <90 or sig O2 desat (can draw ABG @ that time, with same criteria as above).
   2. Must perform 2 exams 6 hours apart in addition to apnea test.

One-Legacy 800-338-6112

See Also

• ACLS (Main)
• Post Cardiac Arrest
• Altered Mental Status

Source

2/8/07 DONALDSON (adapted from One-Legacy)