Single or dual brain death exams: Tertiary hospital experience over 11 years
Kananeh M, Louchart L, Brady P, Mehta C, Rehman M, Lewis A, Greer D, and Varelas P. Single or dual brain death exams: Tertiary hospital experience over 11 years. Neurology 2017; 88(16 Suppl 1).
Objective: To evaluate which factors are associated with use of single brain death exam (SBD) vs two (dual) brain death exams (DBD) during brain death (BD) declaration. Background: Since 2006, practitioners in our hospital could choose to perform either a SBD accompanied by an apnea test and a cerebral blood flow test or DBD and an apnea test. Design/Methods: We used our electronic medical records and our local organ procurement organization's database to identify every BD patient in our hospital between 2006 and 2016. We collected data on number of exams, patient characteristics and donation outcome. Results: Of 233 BD declarations, 111 (47.6%) were SBD and 122 (52.4%) were DBD. During the 1st five years, 45.8% of all BD exams were SBD and during the second 52.9%. The mean interval between two exams was 21.4±10.9 hours. There was no association between time from event to first exam or consent for donation and number of exams. SBD was more common in patients who were older (50.48±16.3 for SBD vs 46±17.1 years for DBD, p= 0.041), had a primary neurologic diagnosis (62.3% vs 7.5% without primary neurologic diagnosis, p< 0.001), were admitted to the neuro ICU (71.2% vs 11.1% in the medical ICU, vs 41.3% in the surgical ICU, p< 0.001), had completed the apnea test (48.7% vs 27.5% in those who had not, p=0.033), and had higher PaO2 during the apnea test (223.8±126.6 mm Hg vs 188.9±125.3 mm Hg for DBD, p=0.037). Conclusions: At our institution, BD was more often done by DBD exams, although the primary diagnosis and the Unit of admission influenced the decision. An increased adoption of SBD exams was noted after the 2010 AAN BD Guidelines supporting SBD exam were published. Although the number of exams did not affect rate of consent for donation, DBD patients stayed in the ICUs for a day longer.
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