Interdisciplinary approach in post-cardiac arrest anoxic brain injury with unconfirmed brain death

Severe anoxic brain injury after cardiac arrest can produce a clinical picture suggestive of brain death (BD). However, when ancillary testing, such as radionuclide cerebral perfusion scans (RCPS), shows preserved cerebral perfusion, the diagnosis of brain death cannot be confirmed, complicating end-of-life decision-making. We present a case of a post-cardiac arrest patient with profound neurological injury and absent brainstem reflexes. Although the clinical findings resembled brain death, two RCPS showed preserved cerebral perfusion, ruling out a formal brain death diagnosis. As a result, withdrawal of life-sustaining therapies was not permitted under existing protocols, despite a poor prognosis.