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Critical Care
Published in: Critical Care 1/2020

01-12-2020 | Brain Death | Editorial

How I do a brain death examination: the tools of the trade

Author: Eelco F. M. Wijdicks

Published in: Critical Care | Issue 1/2020

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Excerpt

Brain death has been accepted universally, although practice differences have eluded consensus [1, 2]. Laws and guidelines have not appreciably changed [3, 4] nor have tools of the trade. The following principles remain: establish the reason for coma (most important), exclude known/unknown confounders (equally important), ascertain the futility of intervention (decided before), prepare the patient for testing (to optimize resolution), and acknowledge clinical examination as the benchmark (essential) [5]. One should ask three questions: Have I tried everything to change the clinical picture? Can I proceed? Can I be fooled? …
Literature
1.
Bernat JL. Comment: Is international consensus on brain death achievable? Neurology. 2015;84:1878.CrossRef
2.
3.
Lewis A, Bakkar A, Kreiger-Benson E, Kumpfbeck A, Liebman J, Shemie SD, Sung G, Torrance S, Greer D. Determination of death by neurologic criteria around the world. Neurology. 2020;95:e299–309.CrossRef
4.
Wahlster S, Wijdicks EF, Patel PV, Greer DM, Hemphill JC 3rd, Carone M, Mateen FJ. Brain death declaration: practices and perceptions worldwide. Neurology. 2015;84:1870–9.CrossRef
5.
Wijdicks EF, Varelas PN, Gronseth GS, Greer DM. American Academy of N. Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2010;74:1911–8.CrossRef
6.
Maciel CB, Youn TS, Barden MM, Dhakar MB, Zhou SE, Pontes-Neto OM, Silva GS, Theriot JJ, Greer DM. Corneal reflex testing in the evaluation of a comatose patient: an ode to precise semiology and examination skills. Neurocrit Care. 2020;33:399–404.CrossRef
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Beam WB, Scott PD, Wijdicks EFM. The physiology of the apnea test for brain death determination in ECMO: arguments for blending carbon dioxide. Neurocrit Care. 2019;31:567–72.CrossRef
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Daneshmand A, Rabinstein AA, Wijdicks EFM. The apnea test in brain death determination using oxygen diffusion method remains safe. Neurology. 2019;92:386–7.CrossRef
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Hocker S, Schumacher D, Mandrekar J, Wijdicks EF. Testing confounders in brain death determination: a new simulation model. Neurocrit Care. 2015;23:401–8.CrossRef
Metadata
Title
How I do a brain death examination: the tools of the trade
Author
Eelco F. M. Wijdicks
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Brain Death
Published in
Critical Care / Issue 1/2020
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-020-03376-6

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