Muerte cerebral

Evidence-based guideline update: Determining brain death in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology Eelco F.M. Wijdicks, Panayiotis N. Varelas, Gary S. Gronseth and David M. Greer Neurology 2010;74;1911-1918 DOI: 10.1212/WNL.0b013e3181e242a8

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Neurology® is the official journal of the American Academy of Neurology. Published continuously since 1951, it is now a weekly with 48 issues per year. Copyright © 2010 by AAN Enterprises, Inc. All rights reserved. Print ISSN: 0028-3878. Online ISSN: 1526-632X.

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SPECIAL ARTICLE

Evidence-based guideline update: Determining brain death in adults
Report of the Quality Standards Subcommittee of the American Academy of Neurology
Eelco F.M. Wijdicks, MD, PhD Panayiotis N. Varelas, MD, PhD Gary S. Gronseth, MD David M. Greer, MD, MA
ABSTRACT

Objective:To provide an update of the 1995 American Academy of Neurology guideline with regard
to the following questions: Are there patients who fulfill the clinical criteria of brain death who recover neurologic function? What is an adequate observation period to ensure that cessation of neurologic function is permanent? Are complex motor movements that falsely suggest retained brain function sometimesobserved in brain death? What is the comparative safety of techniques for determining apnea? Are there new ancillary tests that accurately identify patients with brain death?

Address correspondence and reprint requests to the American Academy of Neurology, 1080 Montreal Avenue, St. Paul, MN 55116 guidelines@aan.com

Methods: A systematic literature search was conducted and included a review ofMEDLINE and EMBASE from January 1996 to May 2009. Studies were limited to adults (aged 18 years and older). Results and recommendations: In adults, there are no published reports of recovery of neurologic
function after a diagnosis of brain death using the criteria reviewed in the 1995 American Academy of Neurology practice parameter. Complex-spontaneous motor movements and falsepositivetriggering of the ventilator may occur in patients who are brain dead. There is insufficient evidence to determine the minimally acceptable observation period to ensure that neurologic functions have ceased irreversibly. Apneic oxygenation diffusion to determine apnea is safe, but there is insufficient evidence to determine the comparative safety of techniques used for apnea testing. There is insufficientevidence to determine if newer ancillary tests accurately confirm the cessation of function of the entire brain. Neurology® 2010;74:1911–1918
GLOSSARY
AAN American Academy of Neurology; CI confidence interval; CPAP continuous positive airway pressure; CTA CT angiography; HMPAO Tc 99mHexametazime; MRA magnetic resonance angiography; PEEP positive end-expiratory pressure; SSEP somatosensoryevoked potential; TCD transcranial Doppler; UDDA Uniform Determination of Death Act.

The President’s Commission report on “guidelines for the determination of death”1 culminated in a proposal for a legal definition that led to the Uniform Determination of Death Act (UDDA). The act reads as follows: “An individual who has sustained either 1) irreversible cessation of circulatory and respiratoryfunctions, or 2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made with accepted medical standards.”2 Most US state laws have adopted the UDDA. Several states have added amendments regarding physician qualifications, confirmation by a second physician, or religious exemption.
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