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[Current concepts in diagnosing brain death in Germany].
1Klinik und Poliklinik für Neurologie, Johannes-Gutenberg-Universität Mainz. toemke@neurologie.klinik.uni-mainz.de
Medizinische Klinik (Munich, Germany : 1983)
|March 14, 2000
Summary
Diagnosing brain death involves identifying an acute central nervous system (CNS) catastrophe and ruling out confounding conditions. Clinical signs like coma, absent brainstem reflexes, and apnea, confirmed over time or with tests, determine brain death.
Area of Science:
- Neurology
- Critical Care Medicine
- Forensic Medicine
Background:
- Brain death diagnosis relies on evidence of acute CNS catastrophe.
- Complicating medical conditions must be excluded for accurate assessment.
- Causes include primary (e.g., hemorrhage) and secondary (e.g., hypoxia) brain damage.
Purpose of the Study:
- To outline the diagnostic criteria and confirmatory procedures for brain death.
- To detail the specific protocols and timelines for clinical evaluation in Germany.
- To clarify the role of confirmatory tests in diagnosing brain death.
Main Methods:
- Clinical assessment focusing on coma, absence of brainstem reflexes, and apnea.
- Observation of the persistence of these cardinal signs.
- Utilizing confirmatory tests like electroencephalography (EEG) or neuroimaging (Doppler ultrasonography, isotope angiography) when necessary.
Main Results:
- Cardinal signs of brain death are coma, absent brainstem reflexes, and apnea.
- German guidelines specify observation intervals: ≥12 hours for primary, ≥72 hours for secondary brain damage.
- Confirmatory tests are not always mandatory but required for newborns, infants <2 years, and those with infratentorial damage.
Conclusions:
- Brain death is primarily a clinical diagnosis.
- Confirmatory tests serve to support the clinical diagnosis, especially in specific patient groups.
- Adherence to established diagnostic criteria ensures accurate determination of brain death.