Neuroanesthesia & neurocritical care
The 2023 American Academy of Neurology, American Academy of Pediatrics, Child Neurology Society, and Society of Critical Care Medicine Pediatric and Adult Brain Death/Death by Neurologic Criteria Determination Consensus Guidelines: What the Critical Care Team Needs to Know*
Recommendations
As issued by the authors
BD/DNC is permanent loss of function of the brain as a whole, incl. the brain stem, resulting in coma, brainstem areflexia and apnea with an adequate stimulus
Sufficient observation period to ensure no chance of recovery, then exclusion of confounders (hypothermia, hypotension, severe metabolic disturbances, medication effects)
Specific guidance for patients treated with therapeutic hypothermia or medical/surgical interventions for intracranial hypertension
Structured, meticulous neurologic examination with the responses consistent with BD/DNC detailed
Protocol for safe apnea testing, incl. modifications for patients on ECMO
Controversial issues addressed: consent, BD/DNC evaluation in pregnancy, preservation of neuroendocrine function, primary posterior fossa injuries
Original publication
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