Patient with Only Brain Stem Function Prognosis: Understanding the Criteria for Declaring Brain Death

The concept of brain death has been a topic of debate among medical professionals and ethicists for decades. In 1976, the Conference of Royal Medical Colleges came to a consensus that brainstem death constitutes brain death. This definition has since been widely accepted and is used as a benchmark for declaring brain death.

Brain death is typically indicated when apnea testing is not hemodynamically tolerated or when only one neurologic examination is desirable, such as in cases where organ procurement for transplantation is necessary. Mollart and Goulon first coined the term 'coma depasse,' meaning a state beyond coma, to describe this condition.

To confirm brain death, clinicians use a combination of clinical criteria and diagnostic tests. These may include assessment of oculovestibular, oculocephalic, and corneal reflexes, as well as electroencephalography (EEG) or tests of brain perfusion to determine the absence of brain activity or blood flow.

In adults, at least one complete brain death assessment by a clinician must be performed, followed by an additional examination conducted either by the same or another independent clinician to reduce the risk of false-positive assessments. For children, some states recommend performing two separate examinations by independent clinicians separated by at least 48 hours.

The criteria for declaring brain death in adults include:

1. Exclusion of all complicating medical conditions

2. Comprehensive neurologic examination with required testing

3. Systolic blood pressure ≥100 mm Hg and arterial pressure ≥75 mm Hg

4. Core temperature >36°C for at least 24 hours if hypothermia is present

Clinicians who evaluate brain death must have sufficient training and be credentialed, while potentially reversible metabolic abnormalities must also be excluded.

Brain death should not be declared or considered in cases where:

1. Potentially anesthetizing or paralyzing medications are used

2. Illicit drugs, including self-administered substances, are present

To declare brain death in patients ≥37 weeks old, the following requirements must be met:

1. A known catastrophic and permanent brain injury must have occurred

2. A structural or metabolic cause of brain damage must be present

3. Serial determination of clinical criteria to demonstrate permanent loss of brain function, including that of the brain stem

In conclusion, declaring brain death in a patient with only brain stem function requires careful consideration of the clinical criteria and diagnostic tests. Clinicians must ensure that all complicating medical conditions are excluded and that sufficient training and credentialing have been achieved before making this determination.

Patient with only brain stem function prognosis