Department of Clinical Neurophysiology, Marqués de Valdecilla University Hospital, Santander, Cantabria, Spain; Department of Physiology and Pharmacology, University of Cantabria (UNICAN), Santander, Cantabria, Spain; Instituto de Formación e Investigación Marqués de Valdecilla (IFIMAV), Santander, Spain.
Clin Neurophysiol. 2013 Dec;124(12):2362-7. doi: 10.1016/j.clinph.2013.05.028. Epub 2013 Jul 9.
To describe the causes and outcome of adult patients with preserved electroencephalographic activity despite clinical findings suggesting brain death (BD), and its impact on organ donation.
Retrospective study of the clinical and electroencephalography (EEG) data of all adult patients admitted to our hospital between January 2001 and December 2011 in whom a comprehensive clinical diagnosis of BD was reached following absence of brainstem reflexes and confirmatory apnea tests, were obtained. All patients with clinical findings suggesting BD and an EEG showing brain activity were selected for the analysis. We calculated the brain death interval (BDI) as the time between the first complete clinical examination and confirmatory ancillary test, or the time between the first and second complete clinical examination for BD, in order to analyze the impact on family consent for organ donation.
A complete clinical examination and EEG were diagnostic in 289 patients. In 279 (96.5%), the first EEG showed electrocerebral inactivity corroborating the clinical findings of BD. The mean BDI in this group was 4.2 ± 5.8h (median; 1.8[1.0-3.5]). This value was significantly lower than in the group in which only two full clinical evaluations were performed (p<0.0001). In 10 out 289 (3.5%), the first EEG showed at least some brain activity. The mean BDI in this group was 27.2 ± 13.8h (median; 22.9 [19.1-31.2]). In two cases, a third EEG was necessary before obtaining electrocerebral inactivity. A BDI>6h, was positively associated with a family refusal for organ donation (p=0.02).
The rate of EEGs with electrocerebral activity despite clinical findings suggesting BD was only 3.5%. It occurred most frequently with severe brainstem damage. Although in this small percentage of patients, BD diagnosis was notably delayed, in the great majority of cases the use of EEG shortened the BDI. In our series, a BD diagnosis delay >6h negatively affected consent for organ donation.
The use of EEG can decrease the time interval for brain death diagnosis.
描述成人患者尽管临床发现提示脑死亡（BD），但脑电图（EEG）仍显示有活动的原因和结果，并探讨其对器官捐献的影响。
对 2001 年 1 月至 2011 年 12 月期间我院收治的所有成人患者的临床和 EEG 数据进行回顾性研究，这些患者在排除脑干反射和确认性窒息试验后，综合临床诊断为 BD。所有临床发现提示 BD 且 EEG 显示有脑活动的患者均被纳入分析。我们计算脑死亡间隔（BDI），即首次全面临床检查和确认性辅助检查之间的时间，或首次和第二次 BD 全面临床检查之间的时间，以分析其对器官捐献的影响。
289 例患者进行了全面的临床检查和 EEG。279 例（96.5%）的首次 EEG 显示电脑无活动，证实了 BD 的临床发现。该组的平均 BDI 为 4.2 ± 5.8h（中位数；1.8[1.0-3.5]）。该值明显低于仅进行两次全面临床评估的组（p<0.0001）。289 例中有 10 例（3.5%）的首次 EEG 显示至少有一些脑活动。该组的平均 BDI 为 27.2 ± 13.8h（中位数；22.9 [19.1-31.2]）。在 2 例中，需要进行第三次 EEG 才能获得电脑无活动。BDI>6h 与家庭拒绝器官捐献呈正相关（p=0.02）。
尽管临床发现提示 BD，但 EEG 显示电脑有活动的比例仅为 3.5%。它最常发生在严重的脑干损伤中。尽管在这一小部分患者中，BD 诊断明显延迟，但在大多数情况下，EEG 的使用缩短了 BDI。在我们的系列中，BD 诊断延迟>6h 会对器官捐献的同意产生负面影响。
EEG 的使用可以缩短脑死亡诊断的时间间隔。
