Brain death means there is no recovery. Unfortunately, up until now, not all medical institutions have been on the same page when it comes to determining brain death. For the first time in fifteen years, the American Academy of Neurology has issued new brain death guidelines with recommendations which provide step-by-step instructions to help guide clinical decision making.
Published in the June 8 issue of Neurology, the new guidelines focusing on patients eighteen years and older were revealed. (There is another group currently working on guidelines for children.) “The new recommendations are encouraging uniformity and thoroughness among institutions,” says Dr. James Bernat, MD, from Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire. He says he hopes they will help address the wide variation among hospitals.
Functions of the brain
The brain controls all of our bodily functions. Knowing this, you might be surprised to learn that there are three things that the brain cannot do. First, the brain can feel pain all over the body, but it cannot feel pain within itself. The brain also cannot store oxygen. Finally, the brain cannot store glucose (blood sugar). When the brain loses all neurological function, it is considered dead.
Signs that a brain has permanently stopped functioning
Brain death occurs when the brain isn’t capable of sustaining the rest of the body’s systems anymore without life support. The concept of brain death materialized in the United States in the 1960s when the ability to resuscitate people and to mechanically keep the heart and lungs functioning became established. According to the new guidelines, there are three signs that a brain has permanently stopped functioning: the person is comatose; all brainstem reflexes have stopped working; and breathing has permanently stopped.
How is brain death diagnosed?
Some clinicians previously believed that more than one exam is necessary to diagnose a brain death, which makes sense. Wouldn’t you want to be positive your loved one was no longer able to live without life support before it was taken away?
“The original guideline did not require this either, but I think it was a common misconception that two exams are necessary. This is not the case,” said Dr. Gary Gronseth, MD, from the University of Kansas, Kansas City. “Some people may object, but we found that one exam was sufficient.”
There are several steps which must be followed in order to diagnose brain death in a patient. The new brain death guidelines outline the best way in which to demonstrate absence of breathing. They also state that certain laboratory tests, such as cerebral blood flow studies, aren’t always necessary. However, diagnosis does have to be done by a doctor who has the necessary skill and experience in diagnosing brain death.
Hopefully, with the release of these new guidelines, medical institutions will finally be on the same page when determining brain death in their patients. “We wanted to provide useful tools to help clinicians,” Dr. Gronseth said, “but many factors will still need to be based on clinical judgment.”
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