Walter Uwe, Brandt Stephan A
Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Gehlsheimer Str. 20, 18147, Rostock, Deutschland.
Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
Nervenarzt. 2019 Oct;90(10):1021-1030. doi: 10.1007/s00115-019-0765-8.
The determination of the irreversible cessation of brain function (ICBF) is conducted in Germany according to the guideline of the German Medical Association, which is currently its fourth update issued in July 2015. This article provides an assessment of the current situation including an international comparison. International case reports with allegedly incorrect ICBF diagnosis are reviewed from the point of view of the German guideline. These case reports underpin the validity of the German guideline, especially its following provisions: (1) in patients with known or suspected adaptation to chronic hypercapnia, apnea cannot be diagnosed as usual; therefore in such a case the proof of cerebral circulatory arrest is mandatory; (2) if perfusion scintigraphy is used for proof of cerebral circulatory arrest, only validated lipophilic radiopharmaceuticals are allowed. This is compatible with new research data which indicate that cellular function can be reactivated for several hours after circulatory arrest but not the brain function. The recently updated recommendations of the German Society for Clinical Neurophysiology and Functional Imaging (DGKN) for ancillary testing include editorial adaptations (e.g., the more precise specification of the electrode positions for electroencephalography), standards of display screen with digital electroencephalography and age-related minimum values of mean arterial pressure for Doppler and duplex sonography in children. The novel requirements regarding the institutional organization of ICBF diagnostics in Germany issued in the "Second law on the amendment of transplantation law-improvement of the cooperation and the framework for organ donation" that became effective recently are presented and discussed critically in this review.
在德国，脑功能不可逆性停止（ICBF）的判定是依据德国医学协会的指南进行的，该指南目前是其于2015年7月发布的第四次更新版本。本文对当前情况进行了评估，包括国际比较。从德国指南的角度对一些据称ICBF诊断有误的国际病例报告进行了审查。这些病例报告证实了德国指南的有效性，尤其是其以下规定：（1）对于已知或疑似适应慢性高碳酸血症的患者，不能像往常一样诊断为呼吸暂停；因此在这种情况下，必须证明脑循环停止；（2）如果使用灌注闪烁显像来证明脑循环停止，仅允许使用经过验证的亲脂性放射性药物。这与新的研究数据相符，这些数据表明循环停止后细胞功能可在数小时内重新激活，但脑功能不行。德国临床神经生理学和功能成像学会（DGKN）最近更新的辅助检查建议包括编辑方面的调整（例如，脑电图电极位置的更精确规范）、数字脑电图显示屏标准以及儿童多普勒和双功超声检查中与年龄相关的平均动脉压最低值。本文对最近生效的《移植法修正案第二部——改善器官捐赠合作与框架法》中发布的关于德国ICBF诊断机构组织的新要求进行了介绍并批判性地进行了讨论。
