Auditory brain-stem response in determination of brain death.

A diagnosis of brain death requires evidence of irreversible destruction (or dysfunction) of neurons in the brain stem and cerebrum. The physical examination is not a valid index of brain integrity in patients who are drug-intoxicated or receiving therapeutic paralyzing agents or high-dose barbiturates. We evaluated the use of the auditory brain-stem response (ABR) as an ancillary test in the determination of brain death. A total of 100 combined ABR and nuclear cerebral blood flow studies were completed at bedside with 81 acute, severely brain-injured adults. The ABR and cerebral blood flow outcomes were significantly correlated. We conclude that the ABR is a clinically feasible and useful procedure in the determination of brain death, especially in patients whose medical therapy compromises the neurologic examination.