Prerequisites
Examination
Apnea test
Irreversible coma with known cause
No pupillary reaction to light
Hemodynamically stable
Imaging explaining coma
No corneal reflex
Normal carbon dioxide level while on ventilator (PaCO2 35–45 mmHg)
No CNS depressant drugs
No oculocephalic reflex
Pre-oxygenation with 100 % FiO2 for greater than 10 min such that PaO2 is greater than 200 mmHg
No residual muscle relaxing drugs
No oculovestibular reflex
Positive end-expiratory pressure (PEEP) 5 cmH2O
No severe acid–base, electrolyte or endocrine imbalance
No facial movements to stimulation at eye or temporomandibular joint
Provide oxygen either by suction catheter at the carina at 6 L/min or a connector to endotracheal tube at a continuous positive airway pressure (CPAP) of 10 cmH2O
Normal body temperature
No gag reflex
Systolic blood pressure greater than 100 mmHg
No cough when stimulated
No spontaneous respirations
No limb movement when stimulated
Prerequisites
In order to be evaluated for brain death, the patient must be in a coma of known and irreversible cause. These include ischemic or hemorrhagic stroke, trauma and cerebral herniation. There must be imaging of the brain, either computerized tomography (CT) or magnetic resonance imaging (MRI) scan that can explain the neurological condition.
All drugs that can affect the neurological exam should have been stopped and allowed sufficient time that they have no further impact on the patient. There are some drugs such as neuromuscular blocking agents that can affect evaluation of brain death. The lingering effects these drugs however, can be evaluated with neuromuscular evaluation.
The patient must have a normal body temperature, defined as being greater than or equal to 36 °C. Finally, there should be no derangement in the patient’s electrolyte balance, acid–base disturbances in the blood or endocrine dysfunction.
Before beginning the examination, the physician verifies that the patient’s blood pressure is greater than 100 mmHg and that they are not spontaneously breathing.
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