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Updated: Jul 31, 2025
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Measuring the Carotid to Femoral Pulse Wave Velocity Cf-PWV to Evaluate Arterial Stiffness
Published on: May 3, 2018
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Brain-based arterial pulse pressure threshold for death determination: a systematic review
Saptharishi Lalgudi Ganesan1,2, Laura Hornby3, Matthew Weiss4,5
1Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada. rishi.ganesan@lhsc.on.ca.
Summary
A pulse pressure greater than 5 mm Hg may lead to incorrect death diagnoses. Insufficient evidence exists for thresholds between 0 and 5 mm Hg for determining circulatory death.
Area of Science:
- Medical Ethics
- Critical Care Medicine
- Forensic Pathology
Background:
- Lack of consensus exists on the minimum arterial pulse pressure for confirming circulatory death, particularly in organ donation.
- Accurate determination of circulatory death is critical for both patient prognosis and organ procurement.
Approach:
- A systematic review was conducted, searching multiple databases (MEDLINE, Embase, CENTRAL, Web of Science) up to August 2021.
- Included studies involved direct or indirect evidence on arterial pulse pressure monitoring during circulatory arrest or death determination.
- Five studies of sufficient quality were included for evidence profiling.
Key Points:
- One study indicated persistent cerebral activity (EEG < 2 μV) at pulse pressures up to 8 mm Hg.
- Indirect evidence suggests a pulse pressure threshold > 5 mm Hg may lead to misdiagnosis of death by circulatory criteria.
- There is insufficient evidence to support any pulse pressure threshold between 0 and 5 mm Hg for safe determination of circulatory death.
Conclusions:
- Clinicians should be cautious when using arterial pulse pressure thresholds greater than 5 mm Hg for death determination.
- Further research is needed to establish a definitive and safe pulse pressure threshold for confirming circulatory death.
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