Declaring pediatric brain death: current practice in a Canadian pediatric critical care unit

Area of Science:

• Pediatric Critical Care Medicine
• Neurology
• Forensic Medicine

Background:

• Brain death diagnosis in pediatric patients presents unique challenges.
• Established guidelines exist for adult brain death determination, but pediatric application requires specific considerations.
• Accurate diagnosis is crucial for organ donation and family care decisions.

Purpose of the Study:

• To document the criteria and methods used for declaring brain death in a pediatric critical care unit (PCCU).
• To assess the application of clinical criteria and ancillary tests in pediatric brain death diagnosis.
• To identify potential gaps in current practices, particularly for neonates and infants.

Main Methods:

• Retrospective chart review of 60 pediatric patients (≤16 years) declared brain dead between 1987 and 1992.
• Analysis of clinical criteria documentation, including coma, reflexes, and apnea testing.
• Review of ancillary tests such as electroencephalography (EEG) and cerebral blood flow (CBF) studies.

Main Results:

• Brain death was diagnosed using clinical criteria in 39 patients and suspected in 21 cases where criteria were not fully applicable.
• Ancillary tests (EEG, CBF) were used in 33 patients.
• EEG demonstrated electrocerebral silence in all tested patients; CBF studies showed absent or abnormal flow in most cases.

Conclusions:

• Pediatricians in this tertiary care center utilize clinical criteria aligned with established guidelines for diagnosing brain death in children, including neonates.
• Ancillary investigations are consistently employed when clinical criteria are not fully applicable.
• The established practice for adults and older children needs further validation for neonates and infants.