Department of Neurology, Yale University School of Medicine, New Haven, Connecticut.
Department of Neurology, Henry Ford Hospital, Detroit, Michigan.
JAMA Neurol. 2016 Feb;73(2):213-8. doi: 10.1001/jamaneurol.2015.3943.
Brain death is the irreversible cessation of function of the entire brain, and it is a medically and legally accepted mechanism of death in the United States and worldwide. Significant variability may exist in individual institutional policies regarding the determination of brain death. It is imperative that brain death be diagnosed accurately in every patient. The American Academy of Neurology (AAN) issued new guidelines in 2010 on the determination of brain death.
To evaluate if institutions have adopted the new AAN guidelines on the determination of brain death, leading to policy changes.
DESIGN, SETTING, AND PARTICIPANTS: Fifty-two organ procurement organizations provided US hospital policies pertaining to the criteria for determining brain death. Organizations were instructed to procure protocols specific to brain death (ie, not cardiac death or organ donation procedures). Data analysis was conducted from June 26, 2012, to July 1, 2015.
Policies were evaluated for summary statistics across the following 5 categories of data: who is qualified to perform the determination of brain death, what are the necessary prerequisites for testing, details of the clinical examination, details of apnea testing, and details of ancillary testing. We compared these data with the standards in the 2010 AAN update on practice parameters for brain death.
A total of 508 unique hospital policies were obtained, representing the majority of hospitals in the United States that would be eligible and equipped to evaluate brain death in a patient. Of these, 492 provided adequate data for analysis. Although improvement with AAN practice parameters was readily apparent, there remained significant variability across all 5 categories of data, such as excluding the absence of hypotension (276 of 491 policies [56.2%]) and hypothermia (181 of 228 policies [79.4%]), specifying all aspects of the clinical examination and apnea testing, and specifying appropriate ancillary tests and how they were to be performed. Of the 492 policies, 163 (33.1%) required specific expertise in neurology or neurosurgery for the health care professional who determines brain death, and 212 (43.1%) stipulated that an attending physician determine brain death; 150 policies did not mention who could perform such determination.
Hospital policies in the United States for the determination of brain death are still widely variable and not fully congruent with contemporary practice parameters. Hospitals should be encouraged to implement the 2010 AAN guidelines to ensure 100% accurate and appropriate determination of brain death.
脑死亡是整个大脑功能不可逆转的停止，它是美国和全球范围内医学和法律上认可的死亡机制。在确定脑死亡方面，个体机构政策可能存在显著差异。至关重要的是，要在每个患者中准确诊断脑死亡。美国神经病学学会（AAN）于 2010 年发布了关于确定脑死亡的新指南。
评估机构是否采用了关于确定脑死亡的新 AAN 指南，导致政策发生变化。
设计、地点和参与者：52 个器官获取组织提供了与确定脑死亡标准相关的美国医院政策。这些组织被指示获取专门针对脑死亡的协议（即，不是心脏死亡或器官捐献程序）。数据分析于 2012 年 6 月 26 日至 2015 年 7 月 1 日进行。
根据以下 5 类数据对政策进行评估：谁有资格进行脑死亡的确定、测试的必要前提条件是什么、临床检查的详细信息、呼吸暂停测试的详细信息以及辅助测试的详细信息。我们将这些数据与 2010 年 AAN 更新的脑死亡实践参数标准进行了比较。
共获得 508 份独特的医院政策，代表了美国大多数有资格和设备评估患者脑死亡的医院。其中，492 份提供了足够的数据进行分析。尽管 AAN 实践参数的改进显而易见，但所有 5 类数据仍然存在显著差异，例如排除低血压（491 项政策中的 276 项[56.2%]）和低体温（228 项政策中的 181 项[79.4%]），规定了临床检查和呼吸暂停测试的所有方面，以及规定了适当的辅助测试以及如何进行这些测试。在 492 项政策中，163 项（33.1%）要求确定脑死亡的医疗保健专业人员具有神经病学或神经外科学的特定专业知识，212 项（43.1%）规定主治医生确定脑死亡；150 项政策没有提及谁可以进行这样的确定。
美国确定脑死亡的医院政策仍然存在广泛差异，并且与当代实践参数不完全一致。应鼓励医院实施 2010 年 AAN 指南，以确保 100%准确和适当确定脑死亡。
