Abstract
Purpose
The acceptance of brain death by society has allowed for the discontinuation of “life support” and the transplantation of organs. In Canada we accept the clinical criteria for brain death (essentially brain stem death) when they can be legitimately applied. Ancillary tests are needed when these clinical criteria cannot be applied or when there are confounders. Ancillary tests include tests of intracranial blood circulation, electrophysiological tests, metabolic studies and tests for residual vagus nerve function. The ideal confirmatory test is one which, when positive, would be incompatible with recoverable brain function (i.e., has no false positives), is not influenced by drugs or metabolic disturbances and which can be readily applied. A critical review of the various ancillary tests used to support the neurological determination of death (brain death) was undertaken.
Methods
A literature review based on a MEDLINE search of relevant articles published between January 1966 to January 2005 was undertaken.
Results
Tests of whole brain perfusion/intracranial blood circulation are the only ones that meet stated criteria.
Conclusions
At present only cerebral angiography and nuclear medicine tests of perfusion are accepted by Canadian standards, but computed tomography and magnetic resonance angiography should prove to be suitable. Transcranial Doppler studies may be suitable for specific cases once appropriate guidelines are established.
Résumé
Objectif
Ľacceptation de la mort encéphalique par la société a permis ľinterruption du «maintien des fonctions vitales» et la transplantation ďorganes. Au Canada, nous acceptons les critères cliniques de la mort encéphalique (essentiellement, mort du tronc cérébral) quand ils peuvent légitimement s’appliquer. Des tests auxiliaires sont nécessaires quand ces critères ne peuvent être appliqués ou quand ils sont confondants. Ils comprennent les tests de circulation sanguine intracrânienne, les épreuves électrophysiologiques, les études métaboliques et les tests de fonction résiduelle du nerf vague. Le test de confirmation idéal est celui qui, s’il est positif, est incompatible avec une récupération de la fonction cérébrale (donc, sans faux positifs), n’est pas modifié par les médicaments ou les désordres métaboliques et peut être facilement réalisé. Nous avons fait une revue critique des différents tests accessoires utilisés lors de la détermination neurologique de la mort (mort encéphalique).
Méthode
Nous avons recherché les articles pertinents de MEDLINE publiés entre janvier 1966 et janvier 2005.
Résultats
Les tests de perfusion cérébrale totale/de circulation sanguine intracrânienne sont les seuls qui répondent aux critères convenus.
Conclusion
À présent, les seuls tests acceptés par les normes canadiennes sont ľangiographie cérébrale et les tests de perfusion de la médecine nucléaire. La tomodensitométrie et ľangiographie par résonance magnétique devraient se révéler appropriés. Dans des cas spécifiques, les examens de doppler transcrânien peuvent convenir une fois établies les directives appropriées.
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Young, G.B., Shemie, S.D., Doig, C.J. et al. Brief review: The role of ancillary tests in the neurological determination of death. Can J Anesth 53, 620–627 (2006). https://doi.org/10.1007/BF03021855
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DOI: https://doi.org/10.1007/BF03021855