{"id":5718,"date":"2009-06-09T13:06:28","date_gmt":"2009-06-09T13:06:28","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/neurobd\/"},"modified":"2025-05-14T19:09:24","modified_gmt":"2025-05-14T19:09:24","slug":"neurobd","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/neurobd\/","title":{"rendered":"Criteria for Brain Death in Adults and Children"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>Physicians, health care workers, members of the clergy, and laypeople throughout the world have accepted fully that a person is dead when his or her brain is dead.<!--more--><\/p>\n<p><strong>Clinical Criteria for Brain Death in Adults and Children<\/strong><\/p>\n<ul>\n<li>Coma<\/li>\n<li>Absence of motor responses<\/li>\n<li>Absence of pupillary responses to light and pupils at midposition with respect to dilatation (4\u20136 mm)<\/li>\n<li>Absence of corneal reflexes<\/li>\n<li>Absence of caloric responses<\/li>\n<li>Absence of gag reflex<\/li>\n<li>Absence of coughing in response to tracheal suctioning<\/li>\n<li>Absence of sucking and rooting reflexes<\/li>\n<li>Absence of respiratory drive at a PaCO2 that is 60 mm Hg or 20 mm Hg above normal base-line values*<\/li>\n<li>Interval between two evaluations, according to patient\u2019s age<\/li>\n<\/ul>\n<blockquote><p>Term to 2 mo old, 48 hr<br \/>\n&gt;2 mo to 1 yr old, 24 hr<br \/>\n&gt;1 yr to &lt;18 yr old, 12 hr<br \/>\n\u00bb18 yr old, interval optional<\/p><\/blockquote>\n<ul>\n<li>Confirmatory tests<\/li>\n<\/ul>\n<blockquote><p>Term to 2 mo old, 2 confirmatory tests<br \/>\n&gt;2 mo to 1 yr old, 1 confirmatory test<br \/>\n&gt;1 yr to &lt;18 yr old, optional<br \/>\n\u00bb18 yr old, optional<\/p><\/blockquote>\n<p>*PaCO2 denotes the partial pressure of arterial carbon dioxide.<\/p>\n<p><strong>Confirmatory Testing for a Determination of Brain Death<\/strong><\/p>\n<p><strong>Cerebral angiography<\/strong><\/p>\n<ul>\n<li>The contrast medium should be injected under high pressure in both anterior and posterior circulation.<\/li>\n<li>No intracerebral filling should be detected at the level of entry of the carotid or vertebral artery to the skull.<\/li>\n<li>The external carotid circulation should be patent.<\/li>\n<li>The filling of the superior longitudinal sinus may be delayed.<\/li>\n<\/ul>\n<p><strong>Electroencephalography<\/strong><\/p>\n<ul>\n<li>A minimum of eight scalp electrodes should be used.<\/li>\n<li>Interelectrode impedance should be between 100 and 10,000 ohm.<\/li>\n<li>The integrity of the entire recording system should be tested.<\/li>\n<li>The distance between electrodes should be at least 10 cm.<\/li>\n<li>The sensitivity should be increased to at least 2 \u00b5V for 30 minutes with inclusion of appropriate calibrations.<\/li>\n<li>The high-frequency filter setting should not be set below 30 Hz, and the low-frequency setting should not be above 1 Hz.<\/li>\n<li>Electroencephalography should demonstrate a lack of reactivity to intense somatosensory or audiovisual stimuli.<\/li>\n<\/ul>\n<p><!-- [if gte mso 9]><xml> <w:WordDocument> <w:View>Normal<\/w:View> <w:Zoom>0<\/w:Zoom> <w:HyphenationZone>21<\/w:HyphenationZone> <w:Compatibility> <w:BreakWrappedTables \/> <w:SnapToGridInCell \/> <w:WrapTextWithPunct \/> <w:UseAsianBreakRules \/> <\/w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4<\/w:BrowserLevel> <\/w:WordDocument> <\/xml><![endif]--><!-- [if gte mso 10]> <mce:style><! \/* Style Definitions *\/ table.MsoNormalTable {mso-style-name:\"Tabla normal\"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:\"\"; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:\"Times New Roman\";} --> <!--[endif] --><\/p>\n<p><strong>Transcranial Doppler ultrasonography<\/strong><\/p>\n<ul>\n<li>There should be bilateral insonation. The probe should be placed at the temporal bone above the zygomatic arch or the vertebrobasilar arteries through the suboccipital transcranial window.<\/li>\n<li>The abnormalities should include a lack of diastolic or reverberating flow and documentation of small systolic peaks in early systole. A finding of a complete absence of flow may not be reliable owing to inadequate transtemporal windows for insonation.<\/li>\n<\/ul>\n<p><strong>Cerebral scintigraphy (technetium Tc 99m hexametazime)<\/strong><\/p>\n<ul>\n<li>The isotope should be injected within 30 minutes after its reconstitution.<\/li>\n<li>A static image of 500,000 counts should be obtained at several time points: immediately, between 30 and 60 minutes later, and at 2 hours.<\/li>\n<li>A correct intravenous injection may be confirmed with additional images of the liver demonstrating uptake (optional).<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><strong>References:<\/strong><\/p>\n<ol>\n<li>Wijdicks EF. The neurologist and Harvard criteria for brain death. Neurology. 2003 Oct 14;61(7):970-6. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/14557571\/\" target=\"_blank\" rel=\"noopener\">[Medline]<\/a><\/li>\n<li>Wijdicks EF. The diagnosis of brain death. N Engl J Med. 2001 Apr 19;344(16):1215-21. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/11309637\/\" target=\"_blank\" rel=\"noopener\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Created: Jun 9, 2009<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[2],"tags":[657,656,622,248,181,16,15,2062,2061,1300,183,1375],"class_list":["post-5718","post","type-post","status-publish","format-standard","hentry","category-neurology","tag-adultos","tag-adults","tag-brain","tag-cerebral","tag-children","tag-criteria","tag-criterios","tag-death","tag-muerte","tag-neurology","tag-ninos","tag-uti"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/5718","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=5718"}],"version-history":[{"count":2,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/5718\/revisions"}],"predecessor-version":[{"id":8982,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/5718\/revisions\/8982"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=5718"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=5718"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=5718"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}