Brain death criteria

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  1. Brain death defines a state of persisting cardiopulmonary function in the absence of cerebral function
  2. Prerequisites prior to brain death determination:
    1. the presence of a clinical or imaging evidence of a CNS catastrophe compatible with brain death
    2. medical conditions such as severe electrolyte, acid-base, endocrine disturbances, drug intoxication, poisoning, or neuromuscular blockade need to be excluded
    3. core body temperature must be 32 degrees C (90 F) or above
    4. significant hypotension ( systolic <90 mmHg or mean <60 mmHg) should be absent
  3. The 3 cardinal findings of brain death are:
    1. coma ( standard painful stimuli result in absence of eye opening or motor response)
    2. absence of brain stem reflexes [ pupillary reflexes to light, corneal responses, oculocephalic reflexes (head turning or caloric testing), gag reflex, cough secondary to bronchial suctioning are all absent]
    3. apnea [spontaneous breathing and ventilatory drive- tested by apnea test, are absent in the context of a core body temperature of 36.5 degrees C (97 F) or above]
  4. In children must usually separate two exams of the above criteria by 12 hours (>12 months), 24 hours (2-12 months) or 48 hours (7 days – 2 months)
  5. Remember: for brain death criteria check for Pain, Pupils and COAGs (Corneal, Oculovestibular, Apnea, Gag)
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