Related Experiment Video
Updated: Aug 12, 2026
Early Pathological and Magnetic Resonance Detection of Cerebral Injury Using a Rat Model of Neonatal Hypoxic Ischemic Encephalopathy
Published on: October 28, 2022
Brain Death Evaluation in Children With Suspected or Confirmed Coronavirus Disease 2019
Matthew P Kirschen1,2, Nancy McGowan3, Alexis Topjian1
1Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Insights
Conducting brain death evaluations during the COVID-19 pandemic requires specific safety measures. Guidance is provided to protect healthcare workers and ensure patient safety during neurologic criteria testing.
Area of Science:
- Neurology
- Critical Care Medicine
- Infectious Disease Epidemiology
Background:
- The coronavirus disease 2019 (COVID-19) pandemic presents unique challenges for performing death by neurologic criteria (DNC) evaluations.
- Healthcare providers face risks of viral transmission, particularly from aerosol generation during neurologic examinations and apnea tests.
- Ensuring patient safety and mitigating transmission risks are paramount during DNC evaluations in the context of COVID-19.
Purpose of the Study:
- To outline the challenges associated with conducting DNC evaluations in patients with COVID-19.
- To provide practical guidance for healthcare professionals to minimize viral transmission risks during DNC testing.
- To ensure the safety of both patients and clinicians throughout the DNC evaluation process.
Main Methods:
- Review of procedures for DNC evaluations, including neurologic examination and apnea testing.
- Identification of aerosol-generating steps within the DNC evaluation process.
- Recommendations for personal protective equipment (PPE) and modified testing techniques, such as using continuous positive airway pressure (CPAP) for apneic oxygenation.
Main Results:
- Aerosol generation during neurologic exams and apnea tests poses a significant transmission risk.
- Utilizing CPAP for apneic oxygenation can mitigate aerosolization during the apnea test.
- Transporting COVID-19 patients for studies like radionuclide cerebral blood flow scans increases risks due to ventilator disconnections.
Conclusions:
- Modifications to the standard neurologic examination and apnea test are essential for DNC evaluations in COVID-19 patients.
- Implementing specific safety protocols, including appropriate PPE and modified techniques, is crucial.
- Careful consideration of transport risks for ancillary studies is necessary to maintain patient and provider safety.
Objectives:
To discuss the challenges of conducting a death by neurologic criteria or brain death evaluation in the coronavirus disease 2019 era and provide guidance to mitigate viral transmission risk and maintain patient safety during testing.
Design:
Not applicable.
Setting:
Not applicable.
Patients:
Children with suspected or confirmed coronavirus disease 2019 who suffer catastrophic brain injury due to one of numerous neurologic complications or from an unrelated process and require evaluation for death by neurologic criteria.
Interventions:
Not applicable.
Measurements And Main Results:
There is a risk to healthcare providers from aerosol generation during the neurologic examination and apnea test for determination of death by neurologic criteria. In this technical note, we provide guidance to mitigate transmission risk and maintain patient safety during each step of the death by neurologic criteria evaluation. Clinicians should put on appropriate personal protective equipment before performing the death by neurologic criteria evaluation. Risk of aerosol generation and viral transmission during the apnea test can be mitigated by using continuous positive airway pressure delivered via the ventilator as a means of apneic oxygenation. Physicians should assess the risk of transporting coronavirus disease 2019 patients to the nuclear medicine suite to perform a radionucleotide cerebral blood flow study, as disconnections to and from the ventilator for transport and inadvertent ventilator disconnections during transport can increase transmission risk.
Conclusions:
When conducting the neurologic examination and apnea test required for death by neurologic criteria determination in patients with suspected or confirmed coronavirus disease 2019, appropriate modifications are needed to mitigate the risk of viral transmission and ensure patient safety.
Related Concept Videos
01:21Cardiopulmonary Resuscitation I: Adult
01:18Viral Meningitis
01:28Traumatic Brain Injury l: Introduction