DY
From the American academy of neurology (a national as opposed to local source)
Evidence-based guideline update: Determining brain death in adults
Checklist for determination of brain death
Prerequisites (all must be checked)
? Coma, irreversible and cause known
? Neuroimaging explains coma
? CNS depressant drug effect absent (if indicated toxicology screen; if barbiturates given, serum level < 10 ?g/mL)
? No evidence of residual paralytics (electrical stimulation if paralytics used).
? Absence of severe acid-base, electrolyte, endocrine abnormality
? Systolic blood pressure ? 100 mm Hg
? NO SPONTANEOUS RESPIRATIONS [emphasis added)
[As for details:]
IX.Apnea.
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Absence of a breathing drive.
Absence of a breathing drive is tested with a CO2 challenge. Documentation of an increase in Paco2 above normal levels is typical practice. It requires preparation before the test.
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Procedure:
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Preoxygenate for at least 10 minutes with 100% oxygen to a Pao2 >200 mm Hg.
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Disconnect the patient from the ventilator.
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Preserve oxygenation ….
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If no respiratory drive is observed, repeat blood gas (Pao2, Paco2, pH, bicarbonate, base excess) after approximately 8 minutes.
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If respiratory movements are absent and arterial Pco2 is ?60 mm Hg …the apnea test result is positive (i.e., supports the clinical diagnosis of brain death).
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