Determination of cerebral death in the pediatric intensive care unit

The clinical course, laboratory data, outcome, and autopsy findings in 61 pediatric patients with suspected brain death were reviewed. In 58% of patients, the initial EEG was isoelectric, and cerebral blood flow was absent. In six of nine children, the initial EEG, which showed activity, became isoelectric by 72 hours. In no child without demonstrable cerebral flow did flow resume in later studies. In four of five children who had initial EEG activity despite absent cerebral flow, an isoelectric EEG developed on repeated study. The average time from initial insult until clinically suspected brain death was 29.5 hours and 61.5 hours until brain death was confirmed. The time from confirmation of brain death until discontinuation of life support systems was 32 hours in the majority of patients. Our current protocol for evaluating pediatric patients with suspected brain death is reviewed with emphasis on the clinical examination, laboratory studies, and use of serial EEGs and radionuclide cerebral blood flow determinations.