Brain Death Its History (and Some Controversies ) Eelco F.M. Wijdicks, MD, PhD Division of Critical Care Neurology Mayo College of Medicine
|
|
- Hester Gilmore
- 5 years ago
- Views:
Transcription
1 Brain Death Its History (and Some Controversies ) Eelco F.M. Wijdicks, MD, PhD Division of Critical Care Neurology Mayo College of Medicine 2016 MFMER
2 Brain Death or 2016 MFMER
3 Where did Brain Death Come from? 2016 MFMER
4 Sir Victor Horsley (1894) If artificial respiration is continued it would be impossible to kill an animal by increased intracranial pressure 2016 MFMER
5 The 1950s and Beginnings of Critical Care 2016 MFMER
6 Neurocatastrophies are Intubated and Ventilated ( the last rite before the end? ) 2016 MFMER
7 Where did the Diagnosis Come from? 2016 MFMER
8 2016 MFMER
9 Where did the Diagnosis Come from? 2016 MFMER
10 2016 MFMER
11 2016 MFMER
12 FRD 1 ROD TOD FRG ROG Th 1 Th MFMER
13 2016 MFMER
14 Coma Dépassé Eyeballs frozen Dilated light fixed pupils Absent blinking with stimuli Absence of swallowing reflexes Jaw droop No motor responses to stimuli No breathing Blood pressure drops progressively 2016 MFMER
15 Neurologic Exam Changes 2016 MFMER
16 No Major Publications MFMER
17 2016 MFMER
18 Henry K. Beecher 2016 MFMER
19 We should, first, abandon the ancient sign of death the cessation of the heartbeat. Beecher 2016 MFMER
20 Meetings Harvard Committee 2016 MFMER
21 Schwab and Adams 2016 MFMER
22 Harvard Criteria (1968) Unreceptivity and unresponsivity No movements or breathing No brainstem reflexes Flat electroencephalogram All of the above tests shall be repeated 24 hours with no change Exclusion of hypothermia (<90 F/32.2 C) or central nervous system depressants 2016 MFMER
23 CP MFMER
24 2016 MFMER
25 2016 MFMER
26 2016 MFMER
27 NIH Collaborative Study ( ) Comatose and no brainstem reflexes Apnea 503 patients Seen as early as 15 minutes Examined 6 hour intervals 2016 MFMER
28 A Subgroup Comatose Apnea Isoelectric EEG 189 patients 187 had cardiac arrest 2 survived (drug intoxication) 2016 MFMER
29 Heart Stops Collapse vascular tone (autonomic uncoupling) Loss of baroreceptor sensitivity and descending regulators Invariate heart rate Decrease contractility Decrease coronary perfusion Myocardial ischemia and arrhythmias Terminal arrest 2016 MFMER
30 US Collaborative Study Apnea was not tested and judged impractical >1/3 of patients had systolic blood pressures <90 mm Hg Intoxications in 15% Missing toxicology screens in 40% 2016 MFMER
31 Collaborative Study Cephalic Reflexes Untested on 503 Initial Examinations (CS) Reflex Patients with reflex untested Pupillary light 2 Corneal 2 Oculocephalic 8 Audio-ocular 12 Snout 15 Jaw jerk 24 Vestibular 44 Cough 72 Pharyngeal 79 Swalling MFMER
32 2016 MFMER
33 Coma President s Commission (1981) Absent brainstem reflexes Apnea with PaCO 2 >60 mm Hg Irreversibility Period of observation determined by clinical judgment Use of cerebral blood flow tests when Brainstem reflexes are not completely testable Sufficient cause cannot be established Shorten period of observation 2016 MFMER
34 2016 MFMER
35 Uniform Determination of Death Act [UDDA] Text of Act An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead A determination of death must be made in accordance with accepted medical standards 2016 MFMER
36 It is the Brainstem! 2016 MFMER
37 2016 MFMER
38 Why Brainstem? 2016 MFMER
39 2016 MFMER
40 Brainstem Death 2016 MFMER
41 Brain Death Areas of Need (AAN Guidelines 1995) Definition of clinical testing of brain stem function Description of conditions that may mimic brain death Interpretation of clinical observations that are compatible with brain death but suggest otherwise Description of apnea testing procedure Validity of confirmatory laboratory tests 2016 MFMER
42 2016 MFMER
43 2016 MFMER
44 US Pediatric Guidelines 2011 What Is Good Comprehensive review literature Useful appendices on medication checklist De-emphasize confirmatory tests 2016 MFMER
45 US Pediatric Guidelines 2011 What Is not so Good Age brackets Confounder evaluation comes after examination Ancillary tests when examination is confounded by medication 2 physicians, 2 apnea tests,12-24 wait Not all physicians (ICU specialists) 2016 MFMER
46 (Not so) Hypothetical Case Car accident 3 teenagers 16, 17, 18 years No brainstems reflexes and apneic 12 hours later Bed A: Bed B: Bed C: 16 yr, SCCM/ACP guidelines, wait for 2 nd exam, cardiac arrest, no organ donation 17 yr, SCCM/ACP guidelines, wait for 2 nd exam, family devastated, want closure, do not want to wait, refuse DCD, no organ donation 18 yr, AAN guidelines, 1 exam, donation follows 2016 MFMER
47 Controversies Do not accept brain death Do not accept any death 2016 MFMER
48 2016 MFMER
49 2016 MFMER
50 Critiques Against Brain Death by Physicians Author Specialty Critique Byrne Pediatrician Brain may be stunned, not dead Evans Cardiologist There is no test of cranial nerve I and II ( patient is in a visual nightmare ) Coimbra Neurologist Apnea test is dangerous and hypercapnia-acidosis may cause vasoconstriction Shewmon Pediatric neurologist Joffe Pediatric intensivist Body may remain alive without brain function and there is no cardiac arrest in several cases Recovery of brain function has been reported 2016 MFMER
51 2016 MFMER
52 2016 MFMER
53 Definition of death is not a scientific question but a social one Individuals and families should be given a choice 2016 MFMER
54 The Real Issues Expertise and competency Uniformity Ancillary tests 2016 MFMER
55 The Examiner How can we define physician competence? Are all specialties really allowed to determine brain death? 2016 MFMER
56 Simulation Brain Death 2016 MFMER
57 1 or 2 Exams? In U.S., 2 exams 8/50 states 2 independent exams? 2 full exams? (1 apnea test) 2 exams lead to marked delay (and loss of donors) 2016 MFMER
58 Mean brain death declaration interval (hr) Waiting for 2 nd exam 12% cardiac arrest Lost procurement Brain dead patients/hospital (no.) 2016 MFMER
59 Confirmatory Test in Brain Death The final judgment must be made on clinical grounds. The physician who would permit such a crucial decision to be made by a machine, ingenious as it might be, leaves himself and his patient in a highly vulnerable position. Raymond D. Adams et al, MFMER
60 2016 MFMER
61 Nuclear Scan Brain death Anterior Lateral Normal 2016 MFMER
62 TCD Brain Death 2016 MFMER
63 CTA Brain Death 2016 MFMER
64 2016 MFMER
65 T incomplete SPECT + F+ CTA + EEG- Now What? 2016 MFMER
66 CP MFMER
67 Preclinical Testing Compliance with American Academy of Neurology Guidelines Hypothermia absent Sedatives absent Electrolyte disorders absent Shock absent Established cause Sedatives and paralytics absent Acid-based disorders absent Endocrine disorders absent 89% 81% 72% 71% 63% 55% 45% 42% Greer et al: Neurology 70:1, MFMER
68 Progress in Unifying Brain Death Determination? Brain death protocols in U.S. News and World Report s Top 50 ranked neurologic institutions Comparison of 2006 with 2015 Wang et al, MFMER
69 Apnea Testing Compliance With AANPP 2015 vs 2008 (%) Absence of respirations Final pco 2 stated ABGs before starting Pre-oxygenation specified pco 2 Use of suppl O 2 Stop if unstable Repeat if inconclusive MFMER
70 2016 MFMER
71 Use of Ancillary Testing in Declaration of Brain Death Worldwide Mandatory Optional Not used EEG Transcranial Doppler MRI Nuclear medicine scan Catheter-based angiography Computed tomography with angiography Country level responders (%) 2016 MFMER
72 Uniform Criteria The Challenge Look below the tentorium There is a clinical dividing line All BSR are lost nothing returns When some is preserved recovery may occur Stick to the bare essentials Cause and confounders Neurologic examination and apnea test 2016 MFMER
73 Unsurvivable brain injury Eliminate any confounders Test brainstem reflexes and motor responses Prepare for apnea test and proceed with CO 2 challenge Note time of death Declare brain dead 2016 MFMER
74 2016 MFMER
75 2016 MFMER
76 Reasons for Decline in Brain Death Determination Reduced gun violence ( gunshot to the head)? More decompressive craniectomy? More often early withdrawal Physicians simply do not consider 2016 MFMER
77 Major Responsibilities Develop rapport with family Determine futility and irreversibility ( absolutely no hope ) Direct initial management of evolving hemodynamic instability Declare brain death (including apnea test procedure) Discussion of organ donation with organ donation agencies 2016 MFMER
78 My brain is dead but they have the rest of my body on a life-support system! 2016 MFMER
Hospital of the University of Pennsylvania POLICY MANUAL
Page 1 of 8 KEY WORDS: Brain Death Coma # 1-6-11 Procedures Following Patient Death # 1-6-13 Organ Donation and Anatomical Donation and Pennsylvania s Anatomical Gift Act #1-6-17 Withholding and Withdrawing
More informationBrain Death Determination: Outline. Definition. Brain Death Determination. Brain Death Determination. No conflict of interest
No conflict of interest : Outline Definition Definition Confounding factors Clinical examination Apnea test Confirmatory testing Communicating the diagnosis Ethical issues Brain death remains the preferred
More informationSample Guidelines for the Determination of Death: Including Death by Neurologic Criteria
Sample Guidelines for the Determination of Death: Including Death by Neurologic Criteria A. SUBJECT: Guidelines for the Determination of Death: Including Death by Neurologic Criteria B. POLICY: The Medical
More informationDeclaring Brain Death. Ali Salim, MD Professor of Surgery Chief, Division of Trauma, Burns, Surgical Critical Care, and Emergency General Surgery
Declaring Brain Death Ali Salim, MD Professor of Surgery Chief, Division of Trauma, Burns, Surgical Critical Care, and Emergency General Surgery Disclosures I have nothing to disclose Why should we know
More informationEthical Challenges With Documenting Brain Death
Ethical Challenges With Documenting Brain Death William Reitsma, BSN, CPTC Consultant AOPO Accreditation Surveyor 2015 Doug Miller Symposium Wisconsin Dells, Wisconsin When are You Dead? History of Brain
More informationGUIDELINES: The following guidelines for determining brain death in adults are accepted practice parameters of the American Academy of Neurology 1
Page 1 of 5 PURPOSE: The purpose of this policy is to provide licensed staff and medical personnel with a guideline to determine when a patient on a ventilator demonstrates clinical brain death. POLICY
More informationName Signature Date IRB & Ethics Committee Dr. Ejaz A. Khan Chairman IRB & EC Dr. Shoukat Matabddin
Prepared by Reviewed By Name Signature Date IRB & Ethics Committee Dr. Ejaz A. Khan Chairman IRB & EC Dr. Shoukat Matabddin Dr. M. Salim Khan Medical Director Approved by Dr. Manzoor H Qazi Chief Executive
More informationDETERMINATION OF NEUROLOGIC DEATH IN ADULTS AND CHILDREN April 2010
Chicago, Illinois PAGE: 1 of 7 DETERMINATION OF NEUROLOGIC DEATH IN ADULTS AND CHILDREN April 2010 Key Content Expert: Medical Center Ethics Committee in consultation with Chiefs of Service for Neurology
More informationThe Determination of Brain Death. James Zisfein, M.D. Chief, Division of Neurology Lincoln Medical Center, Bronx, NY
The Determination of Brain Death James Zisfein, M.D. Chief, Division of Neurology Lincoln Medical Center, Bronx, NY James.Zisfein@nychhc.org The early history of brain death Until recently, death was determined
More informationYALE-NEW HAVEN HOSPITAL CLINICAL ADMINISTRATIVE POLICY & PROCEDURE MANUAL
YALE-NEW HAVEN HOSPITAL CLINICAL ADMINISTRATIVE POLICY & PROCEDURE MANUAL Administrative Policy Title: Brain Death, Guidelines Determination of Death by Neurological Criteria in the Pediatric Patient Manual
More informationNeurological Determination of Death Adult
Approved by: Vice President and Chief Medical Officer Neurological Determination of Death Adult Corporate Policy & Procedures Manual Number: VII-B-400 Date Approved June 9, 2015 Next Review (3 years from
More informationDetermination of Death
Policy Legal Standard UTMB physicians will determine death in accordance with this policy which is based on Texas law and the practice parameters recommended by the American Academy of Neurology for adults
More informationPROPOSED REVISIONS OF ISMA BRAIN DEATH GUIDELINES
RESOLUTION 17-04 Introduced by: Action: PROPOSED REVISIONS OF ISMA BRAIN DEATH GUIDELINES Emil Weber, MD Adopted as Amended RESOLVED, that ISMA adopt updated brain death guidelines for adults and children,
More informationCommittee on Organ Donor Intervention Research
National Academics of Science, Engineering, Medicine Committee on Organ Donor Intervention Research Galen V. Henderson, MD Director, Neurocritical Care Brigham and Women s Hospital Harvard Medical School
More informationPolicy No: Title: Determination of Death by Brain Criteria Department: PATIENT CARE. Originated: May 1992
Title: Determination of Death by Brain Criteria Department: PATIENT CARE Policy No: Page 1 of 6 Revised: April 2009 Previous revisions: 9/96, 7/99, 7/07 Reviewed: August 2010 Originated: May 1992 I. POLICY:
More informationAlex Manara Regional Clinical Lead in Organ Donation South West Region Frenchay Hospital, Bristol
Alex Manara Regional Clinical Lead in Organ Donation South West Region Frenchay Hospital, Bristol Diagnosis of Death Masterclass 2. Increased diagnosis of brain stem death 3. Increased donation after cardiac
More informationBrain Death Examination Importance and Pitfalls. Dr. Reshi Professor of Neurology/Neurosurgery University of Minnesota
Brain Death Examination Importance and Pitfalls Dr. Reshi Professor of Neurology/Neurosurgery University of Minnesota Conflict No Conflicts to report Will not discuss off label use of any medication. Presentation
More informationVariability of brain death determination guidelines in leading US neurologic institutions
Variability of brain death determination guidelines in leading US neurologic institutions David M. Greer, MD, MA Panayiotis N. Varelas, MD, PhD Shamael Haque, DO, MPH Eelco F.M. Wijdicks, MD, PhD Address
More informationAncillary Testing in Death
Ancillary Testing in Death MICHAËL CHASSÉ, MD, PHD, FRCPC ASSISTANT PROFESSOR, DEPARTMENT OF ANESTHESIOLOGY AND CRITICAL CARE, UNIVERSITÉ LAVAL INTENSIVIST, DEPARTMENT OF ANESTHESIOLOGY, DIVISION OF CRITICAL
More informationDetermination of Death by Brain Death Criteria in Adults Page 1 of 10. All attending physicians certified to determine brain death.
Page 1 of 10 Scope: All attending physicians certified to determine brain death. Statutory Background Uniform Determination of Death Act (Adopted in various forms in most states including Connecticut)
More informationBrain Death and Disorders of Consciousness. John Banja, PhD Center for Ethics Emory University
Brain Death and Disorders of Consciousness John Banja, PhD Center for Ethics Emory University jbanja@emory.edu Five kinds of catastrophic neurological injury Minimal Responsiveness Persistent Vegetative
More informationExperiences as a Donation Support Physician. Dead or not Dead? Are the following statements consistent with neurological
Experiences as a Donation Support Physician Dead or not Dead? Are the following statements consistent with neurological determination of death (dead)? or not (not dead)? With thanks to Drs. Alex Manara,
More informationWaiting for a Kidney. Objectives
Waiting for a Kidney Department of Urologic Sciences Grand Rounds William Gourlay Christopher Nguan April 25, 2007 Objectives 1. review the waiting times for deceased-donor kidney transplants in BC and
More informationPractice variability in brain death determination A call to action
Practice variability in brain death determination A call to action Claire N. Shappell, BA Jeffrey I. Frank, MD Khalil Husari, MD Matthew Sanchez, BS Fernando Goldenberg, MD Agnieszka Ardelt, MD, PhD Correspondence
More informationNeurologic Determination of Death. Ian Ball FRCPC Regional Medical Lead for Organ Donation October 26, 2015
Neurologic Determination of Death Ian Ball FRCPC Regional Medical Lead for Organ Donation October 26, 2015 Format Definition of Brain Death Historical Perspectives International consistency / inconsistency
More informationLast printed 9/15/2016 9:51 AM. Departmental/Patient Care Page 1 of 6. Origination Date: 6/18/2014. Grady Memorial Hospital Brain Death Policy
Last printed 9/15/2016 9:51 AM Departmental/Patient Care Page 1 of 6 Grady Memorial Hospital Brain Death Policy Origination Date: 6/18/2014 Revision Date: 2/2/2015 I. POLICY STATEMENT: Mission statement:
More informationUNIVERSITY OF TENNESSEE HOSPITAL 1924 Alcoa Highway * Knoxville, TN (865) LABEL
1003 UNIVERSITY OF TENNESSEE HOSPITAL 1924 Alcoa Highway * Knoxville, TN 37920 (865) 544-9000 LABEL Knoxville Neurology Clinic Orders and Progress tes : NAME: MED REC#: PHYSICIAN: DATE: DATE PHYSICIAN'S
More informationEthical Dilemmas Brain Death and Overdose. Disclosures
Ethical Dilemmas Brain Death and Overdose Ross W. Sullivan MD Director Toxicology Consultation Service Medical Toxicology Fellowship Director Assistant Professor Emergency Medicine SUNY Upstate Hospital,
More informationTake A Breath: Pulmonary Management of the Organ Donor. Whitni Noyes, RN, CPTC Midwest Transplant Network
Take A Breath: Pulmonary Management of the Organ Donor Whitni Noyes, RN, CPTC Midwest Transplant Network Objectives Recognize MTN referral criteria. Be familiar with the apnea test for brain death pronouncement.
More informationSimulation-Based Training In Brain Death Determination
Yale University EliScholar A Digital Platform for Scholarly Publishing at Yale Yale Medicine Thesis Digital Library School of Medicine January 2015 Simulation-Based Training In Brain Death Determination
More informationDefining Death. Defining Death. Defining Death. Death at 50 & Organ Donation ORGAN TRANSPLANTATION. Dying (obvious) Death (not so obvious)
Page 2 Page 4 Page 2 Page 4 Page 3 Page 5 Page 3 Page 5 Death at 50 & Organ Donation Dr. Mark Twite MA MB BChir FRCP Director of Congenital Cardiac Anesthesiology Associate Professor Department of Anesthesiology
More informationUnderstanding Neurological Death
Understanding Neurological Death Special thanks to Trillium Gift Of Life Network s Donor Family Advisory Council, whose dedication and commitment never fail to profoundly move us all. Understanding Neurological
More informationClinical Report Guidelines for the Determination of Brain Death in Infants and Children: An Update of the 1987 Task Force Recommendations
Guidance for the Clinician in Rendering Pediatric Care Clinical Report Guidelines for the Determination of Brain Death in Infants and Children: An Update of the 1987 Task Force Recommendations abstract
More informationPronouncing brain death Contemporary practice and safety of the apnea test
Pronouncing brain death Contemporary practice and safety of the apnea test Eelco F.M. Wijdicks, MD, PhD Alejandro A. Rabinstein, MD Edward M. Manno, MD John D. Atkinson, MD Address correspondence and reprint
More informationBilaga 4 till rapport 1 (17)
Bilaga 4 Tabeller, beskrivning av studier Bilaga 4 till rapport 1 (17) Bilddiagnostik vid misstanke om total hjärninfarkt en systematisk litteraturöversikt, rapport 282 (2018) SBU Statens beredning för
More information뇌사의진단과진단을위한보조적검사 서울아산병원신경과. The Diagnosis and Ancillary Tests of Brain Death. Kim, Cheon-Sik
대한임상검사학회지 : 36 권제 1 호, 64-68, 2004 뇌사의진단과진단을위한보조적검사 김천식 The Diagnosis and Ancillary Tests of Brain Death Kim, Cheon-Sik Department of Clinical Neurosciences, Asan Medical Center Brain death is defined
More informationGUIDELINE for the diagnosis and confirmation of death within Adult Critical Care
Guideline for the diagnosis and confirmation of death within adult critical care 1. Introduction Death occurs when there is permanent loss of capacity for consciousness and loss of all brainstem functions.
More informationQing Yang, MD, PhD Yale School of Medicine. Cultural differences in the acceptance and practice of brain death
Qing Yang, MD, PhD Yale School of Medicine Cultural differences in the acceptance and practice of brain death What is Dying (Obvious) Biomedical Clinical Legal death? Dead (Obvious) Death (Not so obvious)
More informationPulse normal; brain dead
Page 1 of 5 w w w. h a a r e t z. c o m Last update - 03:03 25/09/2007 Pulse normal; brain dead By Avinoam Reches There is no more difficult moment in medicine than when a doctor is required to inform
More informationPost-Arrest Care: Beyond Hypothermia
Post-Arrest Care: Beyond Hypothermia Damon Scales MD PhD Department of Critical Care Medicine Sunnybrook Health Sciences Centre University of Toronto Disclosures CIHR Physicians Services Incorporated Main
More informationRetraction Retracted: Clinical Brain Death with False Positive Radionuclide Cerebral Perfusion Scans
Hindawi Publishing Corporation Volume 2016, Article ID 2057806, 1 page http://dx.doi.org/10.1155/2016/2057806 Retraction Retracted: Clinical Brain Death with False Positive Radionuclide Cerebral Perfusion
More informationSession 15. Brain Death, Permanent Vegetative State, and Medical Futility
American Academy of Pediatrics Bioethics Resident Curriculum: Case-Based Teaching Guides Session 15. Brain Death, Permanent Vegetative State, and Medical Futility Ásdís Finnsdóttir Wagner, DO; Julio Quezada,
More informationBRAIN DEATH. Frequently Asked Questions 04for the General Public
BRAIN DEATH Frequently Asked Questions 04for the General Public Neurocritical Care Society BRAIN DEATH FAQ s FOR THE GENERAL PUBLIC NEUROCRITICAL CARE SOCIETY 1. Q: Why was this FAQ created? A: Several
More informationPost-Cardiac Arrest Syndrome. MICU Lecture Series
Post-Cardiac Arrest Syndrome MICU Lecture Series Case 58 y/o female collapses at home, family attempts CPR, EMS arrives and notes VF, defibrillation x 3 with return of spontaneous circulation, brought
More informationRespiratory Care and Organ Donation
Respiratory Care and Organ Donation Whitni Noyes, RN, OPTC Midwest Transplant Network Midwest Transplant Network CMS requires every accredited hospital to have an agreement with an OPO. MTN is the first
More informationDetermining Brain Death: Will Scientific Certainty Get Us There?
Determining Brain Death: Will Scientific Certainty Get Us There? Alan Sanders Director, Center for Ethics Saint Joseph s Hospital of Atlanta alansanders@sjha.org Introduction In his address to the 18 th
More informationLegal Issues at the End of Life: Who Decides?
Legal Issues at the End of Life: Who Decides? Dan Larriviere, MD, JD University of Virginia Schools of Law and Medicine Chair, American Academy of Neurology Ethics, Law and Humanities Committee My Perspective
More informationDeceased donor. Solid organ transplantation
Deceased donor Solid organ transplantation Deceased donor donation process 1. Potential donor detection 2. Brain death diagnosis 3. Donor management 4. Organ allocation 5. Organ retrieval Brain death Irreversible
More informationFirst Person Consent Uniform Anatomical Gift Act of 1968
Andrew Wilson, Medicolegal Death Investigator Not-for-profit Organ Procurement Organization (OPO) & Tissue Recovery Agency Regulated by Centers for Medicaid and Medicare Services (CMS) and FDA Offices
More informationCase 1. Case 5/30/2013. Traumatic Brain Injury : Review, Update, and Controversies
Case 1 Traumatic Brain Injury : Review, Update, and Controversies Shirley I. Stiver MD, PhD 32 year old male s/p high speed MVA Difficult extrication Intubated at scene Case BP 75 systolic / palp GCS 3
More informationDemographic Data Group Study Cohort Control p N 60 20 Age, Mean (years) 36.3 64.4 < 0.001 Age, Median (years) 33.2 64 < 0.001 Male 41 (68.4%) 4 (20%) 0.001 Female 19 (31.6%) 16 (80%) 0.001 Mechanism of
More informationNEW YORK CITY HEALTH AND HOSPITALS CORPORATION CORPORATE BRAIN DEATH POLICY
NEW YORK CITY HEALTH AND HOSPITALS CORPORATION CORPORATE BRAIN DEATH POLICY PURPOSE: To describe the guidelines, procedure, and documentation requirements for: Initiation of a brain death evaluation, Determination
More informationBabak Tamizi Far MD. Assistant professor of internal medicine Al-zahra hospital, Isfahan university of medical sciences
Babak Tamizi Far MD. Assistant professor of internal medicine Al-zahra hospital, Isfahan university of medical sciences ٢ Level of consciousness is depressed Stuporous patients respond only to repeated
More informationBrain Death: An Investigation of Current Controversies
The University of Akron IdeaExchange@UAkron Honors Research Projects The Dr. Gary B. and Pamela S. Williams Honors College Spring 2018 Brain Death: An Investigation of Current Controversies Meile Moore
More informationNeurological Prognosis after Cardiac Arrest Guideline
Neurological Prognosis after Cardiac Arrest Guideline I. Associated Guidelines and Appendices 1. Therapeutic Hypothermia after Cardiac Arrest 2. Hypothermia after Cardiac Arrest Algorithm II. Rationale
More informationLegal Determination of Brain Death
Research and Reviews Legal Determination of Brain Death JMAJ 54(6): 363 367, 2011 Yoshihiro NATORI* 1 Abstract Revisions to the Organ Transplant Act have made it possible for the organs of a brain-dead
More informationMed 536 Communicating About Prognosis Workshop. Case 2
Med 536 Communicating About Prognosis Workshop Case 2 ID / CC: 33 year-old man with intracranial hemorrhage History of the Presenting Illness 33 year-old man with a prior history of melanoma of the neck
More informationDementia: involves a progressive loss of cerebral functions. The most common form of dementia is Alzheimer s.
Death Forms of Cognitive Disability Locked-In Syndrome: the level and content of consciousness may be normal, but the patient is so severely paralyzed that the patient may appear to have diminished or
More informationBy the end of the talk. Brain death determination in the pediatric population. Disclaimers. What is death? 12/30/2012
Brain death determination in the pediatric population Pedro Weisleder MD PhD Nationwide Children s Hospital By the end of the talk Brain death is a syndrome Cite the components of a brain death determination
More informationEpilepsy CASE 1 Localization Differential Diagnosis
2 Epilepsy CASE 1 A 32-year-old man was observed to suddenly become unresponsive followed by four episodes of generalized tonic-clonic convulsions of the upper and lower extremities while at work. Each
More informationTCD evaluation is used in several countries as a confirmatory test to assess CBF arrest
! BRAIN DEATH IS THE IRREVERSIBLE LOSS OF FUNCTION OF THE ENTIRE BRAIN INCLUDING THE BRAIN STEM Conventional Confirmatory Tests: EEG, CEREBRAL AGF, BRAIN SCINTIGRAPHY LOGISTICAL PROBLEMS TCD evaluation
More informationIndicators for assessing unconsciousness and death during slaughter without stunning
Indicators for assessing unconsciousness and death during slaughter without stunning Antonio Velarde Parma, January, 30th 2013 References - EFSA opinions of 2004 and 2006 on the stunning and killing of
More informationHow to Diagnose Brainstem Death. Akhmad Imron Dept./SMF Bedah Saraf FK.Unpad/RSHS
How to Diagnose Brainstem Death Akhmad Imron Dept./SMF Bedah Saraf FK.Unpad/RSHS RSUP Dr. Hasan Sadikin Bandung Jalan Pasteur No. 38 Bandung telephone.62-022-2034953/57 Fax.62-022-2032216 Diagnosis of
More informationDonation After Circulatory Death From Adults to Pediatrics
Donation After Circulatory Death From Adults to Pediatrics Matthew Weiss, M.D., Pediatric Intensivist, Québec, Québec President of Canadian pdcd Guideline Development Committee CACCN Webinar, February
More informationHypothermia in Neonates with HIE TARA JENDZIO, DNP(C), RN, RNC-NIC
Hypothermia in Neonates with HIE TARA JENDZIO, DNP(C), RN, RNC-NIC Objectives 1. Define Hypoxic-Ischemic Encephalopathy (HIE) 2. Identify the criteria used to determine if an infant qualifies for therapeutic
More informationBrain Death* CARY SUTER, M.D.
Brain Death* CARY SUTER, M.D. Professor and Chairman, Department of Neurology, Medical College of Virginia, Health Sciences Division of Virginia Commonwealth University, Richmond, Virginia Until recently
More informationThe updated guidelines for the determination of brain
Developing a Standard Method for Apnea Testing in the Determination of Brain Death for Patients on Venoarterial Extracorporeal Membrane Oxygenation: A Pediatric Case Series Rima J. Jarrah, MD 1 ; Samuel
More informationSaving Lives & Restoring Health Through Organ and Tissue Donation On-line Module
Saving Lives & Restoring Health Through Organ and Tissue Donation On-line Module 1 N3 Who is New Jersey Organ and Tissue Sharing Network? Organ Procurement Organization (OPO) Private, Non-profit Service
More informationNeurocritical Care Basics. Tapan Kavi, MD Christina Fox, RN
Neurocritical Care Basics Tapan Kavi, MD Christina Fox, RN GOAL 1: DON T LET THE PATIENT DIE Not unique ACLS, ATLS, ENLS, other strategies common to all emergency medical care ABCs MORE not less important
More informationDonation after Circulatory Determination of Death: Ethical Tensions
Donation after Circulatory Determination of Death: Ethical Tensions Robert D. Truog, MD Frances Glessner Lee Professor of Medical Ethics, Anaesthesia, & Pediatrics, Harvard Medical School Director, Center
More informationChronic Brain-Dead Patients Who Exhibit Lazarus Sign
CASE REPORT Korean J Neurotrauma 2017;13(2):153-157 pissn 2234-8999 / eissn 2288-2243 https://doi.org/10.13004/kjnt.2017.13.2.153 Chronic Brain-Dead Patients Who Exhibit Lazarus Sign Department of Neurosurgery,
More informationNeuroprognostication after cardiac arrest
Neuroprognostication after cardiac arrest Sam Orde 1st May 2018 Set the scene 55 yo man, found collapsed in park, looks like he d been jogging, no pulse, bystander CPR, ambulance arrives 5 mins later,
More informationBrain Death Determination in Israel: The First Two Years Experience Following Changes to the Brain Death Law Opportunities and Challenges
Wiley Periodicals Inc. Brief Communication C Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons Brain Death Determination in Israel: The First Two Years
More informationUniversity of Wisconsin - Madison Cardiovascular Medicine Fellowship Program UW CICU Rotation Goals and Objectives
Background: The field of critical care cardiology has evolved considerably over the past 2 decades. Contemporary critical care cardiology is increasingly focused on the management of patients with advanced
More information2/20/2018. Organ Donation after Cardiac Death. STA Introduction. Disclosure. The Need
STA Introduction Organ Donation after Cardiac Death Geoffrey Funk, MD, FACS Associate Medical Director Southwest Transplant Alliance Disclosure Canadian by birth Three degrees from Texas A&M Trauma and
More informationDiagnosis and Declaration of Death: A Dilemma
Review Article Print ISSN: 2321-6379 Online ISSN: 2321-595X DOI: 10.17354/ijss/2016/392 Diagnosis and Declaration of Death: A Dilemma Niranjan Kumar Verma 1, Ashutosh Ranjan 2, Alok Kumar Singh 3 1 Professor
More informationDCD Heart Donation Understanding the Regulatory, Ethical and Clinical Issues. Valluvan Jeevanandam MD University of Chicago Medicine
DCD Heart Donation Understanding the Regulatory, Ethical and Clinical Issues Valluvan Jeevanandam MD University of Chicago Medicine Disclosure Txn None MCS Scientific Advisor Thoratec/Abbott: Chairman
More informationMoron General Hospital Ciego de Avila Cuba. Department of Neurological Surgery
Moron General Hospital Ciego de Avila Cuba Department of Neurological Surgery Early decompressive craniectomy in severe head injury with intracranial hypertension Angel J. Lacerda MD PhD, Daisy Abreu MD,
More informationPost Cardiac Arrest Care 2015 American Heart Association Guideline Update for CPR and Emergency Cardiovascular Care
Post Cardiac Arrest Care 2015 American Heart Association Guideline Update for CPR and Emergency Cardiovascular Care รศ.ดร.พญ.ต นหยง พ พานเมฆาภรณ ภาคว ชาว ส ญญ ว ทยา คณะแพทยศาสตร มหาว ทยาล ยเช ยงใหม System
More informationRhonda Dixon, DVM Section Head, Emergency and Critical Care Sugar Land Veterinary Specialty and Emergency
Rhonda Dixon, DVM Section Head, Emergency and Critical Care Sugar Land Veterinary Specialty and Emergency Traumatic Brain Injury Causes Pathophysiology Neurologic assessment Therapeutic Approach Status
More informationWHEN IT S A MATTER OF LIFE AND DEATH THE QUESTIONS YOU SHOULD ASK EDUCATION FUND
WHEN IT S A MATTER OF LIFE AND DEATH THE QUESTIONS YOU SHOULD ASK EDUCATION FUND WHAT QUESTIONS SHOULD YOU ASK YOUR DOCTOR IN LIFE-OR-DEATH SITUATIONS? Your mother has a stroke and is rushed to the hospital.
More informationBilaga 3 till rapport 1 (5)
Bilaga 3 till rapport 1 (5) som stöd för diagnosen total hjärninfarkt hos barn yngre än två år en systematisk litteraturöversikt, rapport 290 (2018) Bilaga 3 Tabell, beskrivning av studier SBU Statens
More informationMed 536 Communicating About Prognosis Workshop. Case 1
Med 536 Communicating About Prognosis Workshop Case 1 ID / CC: 39 year-old woman status-post motor-vehicle collision History of the Presenting Illness Previously healthy 39 year-old woman was found in
More informationSUPERIOR COURT OF CALIFORNIA COUNTY OF ALAMEDA
Christopher B. Dolan, Esq. (SBN ) Aimee E. Kirby, Esq. (SBN 0) THE DOLAN LAW FIRM Market Street San Francisco, California Tel: (1) 1-00 Fax: (1) 1-0 Attorneys for Plaintiff LATASHA WINKFIELD SUPERIOR COURT
More informationDIAGNOSIS AND MANAGEMENT OF BRAIN DEATH
Med.J.MalaysiaVol.XXXIV No.4 June, 1980 DIAGNOSIS AND MANAGEMENT OF BRAIN DEATH MOHAMED NAMAZIE INTRODUCTION Death is a common human event that a layman knows what it involves. Death is a term so simple
More informationCNS pathology Third year medical students,2019. Dr Heyam Awad Lecture 2: Disturbed fluid balance and increased intracranial pressure
CNS pathology Third year medical students,2019 Dr Heyam Awad Lecture 2: Disturbed fluid balance and increased intracranial pressure ILOs Understand causes and symptoms of increased intracranial pressure.
More informationCURRICULUM FOR FELLOWSHIP IN CRITICAL CARE MEDICINE
CURRICULUM FOR FELLOWSHIP IN CRITICAL CARE MEDICINE AIM: The course has been designed to train candidates by the anesthesiologists in the principles and practice of intensive care & artificial ventilation
More informationCNS pathology Third year medical students. Dr Heyam Awad 2018 Lecture 5: disturbed fluid balance and increased intracranial pressure
CNS pathology Third year medical students Dr Heyam Awad 2018 Lecture 5: disturbed fluid balance and increased intracranial pressure ILOs Understand causes and symptoms of increased intracranial pressure.
More informationBRAIN DEATH S34 (1) Brain Death
BRAIN DEATH S34 (1) Brain Death Last updated: September 5, 2017 CRITERIA FOR BRAIN DEATH... 1 APNEA TEST (S. APNEA CHALLENGE)... 4 ANCILLARY STUDIES... 5 CARE OF ORGAN DONOR... 7 ORGAN DONATION AFTER CARDIAC
More informationSingle Brain Death Examination Is Equivalent to Dual Brain Death Examinations
Neurocrit Care (2011) 15:547 553 DOI 10.1007/s12028-011-9561-4 ETHICAL MATTERS Single Brain Death Examination Is Equivalent to Dual Brain Death Examinations Panayiotis N. Varelas Mohammed Rehman Tamer
More informationAnesthesia Monitoring
Anesthesia Monitoring Horatiu V. Vinerean, DVM, DACLAM Anesthesia Monitoring Anesthesia can be divided into four progressive phases. The signs relating to a certain phase are based upon the presence or
More informationStroke & Neurovascular Center of New Jersey. Jawad F. Kirmani, MD Director, Stroke and Neurovascular Center
Stroke & Neurovascular Center of New Jersey Jawad F. Kirmani, MD Director, Stroke and Neurovascular Center Past, present and future Past, present and future Cerebral Blood Flow Past, present and future
More informationEvidence-based guideline update: Determining brain death in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology
Evidence-based guideline update: Determining brain death in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology Calixto Machado, Joseph S. Jeret, D. Alan Shewmon,
More informationOrganic Mental Disorders. Organic Mental Disorders. Axes. Damrongsak Bulyalert Department of Internal Medicine
Organic Mental Disorders Damrongsak Bulyalert Department of Internal Medicine www.metadon.net 1 Organic Mental Disorders In DSM (Diagnostic and Statistical Manual of Mental Disorders), OMD includes Delirium,
More informationICU Referral For Common Medical Disorders. Prof. M A Jalil Chowdhury
ICU Referral For Common Medical Disorders Prof. M A Jalil Chowdhury Intensive Care Unit (ICU) An intensive care unit (ICU), also known as an critical care unit (CCU), is a special department of a hospital
More informationThe Determination of Death in the Context of Organ Transplantation
The Determination of Death in the Context of Organ Transplantation Medical-ethical guidelines SAMW Schweizerische Akademie der Medizinischen Wissenschaften ASSM Académie Suisse des Sciences Médicales ASSM
More informationTCD IN THE NICU, PICU AND OTHER APPLICATIONS. Dorothy Bulas M.D. Professor of Pediatrics & Radiology Children s National Washington D.C.
TCD IN THE NICU, PICU AND OTHER APPLICATIONS Dorothy Bulas M.D. Professor of Pediatrics & Radiology Children s National Washington D.C. Objectives Recognize normal and abnormal cranial blood flow patterns
More informationPEDIATRIC BRAIN CARE
PEDIATRIC BRAIN CARE The brain matters most! OVERVIEW OF NEURO ASSESSMENT 1. Overall responsiveness/activity 2. The eyes 3.? Increased ICP 4. Movements 5.? Seizures 6. Other OVERALL RESPONSIVENESS/ ACTIVITY
More informationPediatric Cardiac Transplantation Using DCD Donors. Canadian Critical Care Forum David N. Campbell, MD
Pediatric Cardiac Transplantation Using DCD Donors Canadian Critical Care Forum David N. Campbell, MD No disclosures Disclosure Statement DCD: What is Old is New Again Early solid organ recoveries were
More informationUnderstanding the Apnea Test: Procedure with a Predetermined Purpose
Understanding the Apnea Test: Procedure with a Predetermined Purpose Christine M. Zainer, M.D. * and Paul A. Byrne, M.D. ** ABSTRACT: The concept of brain death is controversial but widely accepted in
More information