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Brain death in Canadian PICUs: demographics, timing, and irreversibility
Ari R Joffe1, Sam D Shemie, Catherine Farrell
1Stollery Children's Hospital, John Dossetor Health Ethics Center, University of Alberta, Edmonton, Alberta, Canada. ari.joffe@albertahealthservices.ca
Objectives:
To determine any discordance between first and second brain death examinations and investigate the quality of brain death determination in Canadian PICUs.
Design:
Multicenter retrospective chart review.
Setting:
Four Canadian PICUs.
Patients:
All deaths from 1999 to 2003 were screened. Patients included were 36 wks corrected gestation to 17 yrs old and had at least one brain death examination documented in the chart.
Interventions:
None.
Measurements And Main Results:
Medical records were reviewed to determine demographics, results of the brain death examinations, ancillary tests, and time intervals between injury event, fixed dilated pupils, first brain death examination, second brain death examination, and terminal event. Discordance between brain death examinations was defined as the medical conclusion documented in the chart as brain death followed by no brain death. Prespecified subgroups were age <1 yr vs. ≥ 1 yr and organ donor vs. nonorgan donor. Mann-Whitney-Wilcoxon and unpaired t tests compared time intervals between subgroups; p value ≤ 0.05 was considered significant. Of those screened, 135 of 907 (15%) met the study eligibility criteria and 110 of 135 (81%) had at least two brain death examinations. The prevalence of discordance between brain death examinations was 1 of 110 (0.91%) (95% confidence interval <0.01%-5.5%). In those who had two apnea tests, the prevalence of discordance between brain death examinations was 1 of 63 (1.6%) (95% confidence interval <0.01%-9.3%). Twenty-five (19%) patients had only one brain death examination, and one of these became an organ donor without ancillary testing. Twenty-four (18%) patients did not have an apnea test. Of the 48 (36%) who had only one apnea test, 16 became organ donors without any ancillary test. Patients <1 yr old had a longer time interval between the first and second brain death examinations than those >1 yr old.
Conclusions:
Some brain death diagnoses were not based on two examinations, and some did not include an apnea test. In patients who had two brain death examinations, discordant results were uncommon.
