Evoked potentials: a safe brain-death confirmatory tool?

The diagnosis of brain death (BD) relies primarily on prerequisites (clear knowledge of the cause of coma, all remedial procedures proven unsuccessful) and clinical arguments (areactive coma, loss of brainstem reflexes, apnea). Confirmatory tests should be applied whenever any misleading factor (CNS depressant drugs, hypothermia, metabolic disturbances) can interfere with the clinical diagnosis. This paper reviews the different available confirmatory methods (EEG, four-vessel angiography, radioisotopic techniques, intracranial Doppler, evoked potentials). Both the author's own experience and the data from the literature indicate that evoked potentials are actually a safe and rapid BD confirmatory tool that can be performed at the patient's bedside. It is suggested that they be used in association with the clinical examination for all BD-suspected patients, except for children younger than 6 months of age in whom the guidelines of the Task Force for Brain Death in children (1987) are still recommended.