[Ancillary procedures in the diagnostics of brain death. Utilization, results and consequences in northeastern Germany].

Nervenarzt

Abteilung Neurologie, Bundeswehrkrankenhaus Berlin, Berlin, Deutschland.

Published: February 2016

AI Article Synopsis

  • The study evaluates the use of ancillary tests (ATs) for confirming irreversible brain death in patients across several regions in Germany from 2001 to 2010, focusing on their efficacy based on age and type of brain injury.
  • In a sample of 1,401 patients, ATs were predominantly an electroencephalogram (EEG), with a high confirmation rate of 93.6% for the irreversibility of brain death; however, negative AT results were more frequent in younger patients and those with certain types of brain injuries.
  • The findings suggest that while ATs enhance the diagnostic process in general, they do not independently confirm the absence of all brain functions; a call for standardized diagnostic protocols across hospitals

Article Abstract

Background: According to the German Medical Council guidelines, the proof of irreversible brain death can be carried out using clinical investigations alone or can necessitate the use of ancillary tests (ATs), depending on the patient age and type of brain injury.

Methods: Retrospective evaluation of the diagnostics of irreversible brain death, which were carried out using ATs according to the third edition of the guidelines between January 2001 and December 2010 in Berlin, Brandenburg and Mecklenburg-Western Pomerania and were registered at the German National Foundation for Organ Transplantation.

Results: In 1401 patients (aged 0-94 years) a total of 1636 ATs were carried out. The most frequently used additional procedure for the first AT was an electroencephalogram (EEG) in 71.7 %. Confirmatory results regarding irreversibility were reported for 93.6 % of the initial ATs. Negative results of ATs were less common with primary supratentorial brain lesions (2.9 %) compared to infratentorial lesions (13.7 %), secondary hypoxic brain damage (8.1 %) and children younger than 2 years old (18.5 %). Regardless of the AT results, a return of clinical brain function was never documented. The timing, type and repetition of ATs were variable. In most cases the diagnostic process was clearly accelerated by the use of ATs but was significantly delayed in 10.1 % compared to a purely clinical proof of irreversible brain death.

Conclusion: ATs by themselves do not provide evidence of the cessation of all brain functions. Instead, they are used to prove the irreversibility of the clinically defined syndrome. For patients over 2 years old and in the absence of primary brainstem lesions, clinical re-assessment and ATs are considered to be equally accurate in demonstrating irreversibility. A standardization of diagnostic procedures between hospitals would be desirable.

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Source
http://dx.doi.org/10.1007/s00115-015-0044-2DOI Listing

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