Single or dual brain death exams: Tertiary hospital experience over 11.5 years
Brady P, Kananeh M, Louchart L, Mehta C, Rehman M, Lewis A, Greer D, Mayer S, and Varelas P. Single or dual brain death exams: Tertiary hospital experience over 11.5 years. Neurocritical Care 2017; 27(2):S56.
Introduction: Our hospital policy allows an optional SBD (with an apnea and a cerebral blood flow test) or a DBD (with an apnea test). We have evaluated the adoption of and reason for performing a single brain death exam (SBD) vs two (dual) brain death exams (DBD) and their impact on organ function and consent for organ donation. Methods We evaluated our hospital's BD registry between January 2006 and June 2017 regarding SBD or DBD. We also cross-matched our electronic medical records with the records of the local organ procurement organization. Results Of 251 BD declarations, 115 (46%) were SBD and 136 (54%) DBD. During the 1st five years, 43% of all BD exams were SBD and during the second 57%. Patients with SBD were older (50.6±16.5 for SBD vs 46.5±17.1 years for DBD, p= 0.057), had a primary neurologic diagnosis (96% vs 47%, p< 0.001) and were admitted to the Neuro-ICU (74% vs 27%, p< 0.001). During the 2nd exam, 76.7% patients were on equal or higher dose of pressors. SBD patients had lower K+, BUN, creatinine and heart rate, but higher peak Na+ and apnea PaO2 (for all p<0.05), although apnea pH and PaCO2 were similar. The time between injury to BD pronouncement was shorter in SBD by 29.4 hours. There was no difference in consent rate between SBD and DBD (74% vs 70%, p=0.47). Conclusions At our institution, BD declaration 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, surrogate markers indicated better function of organs after SBD, while DBD patients stayed in the ICUs over a day longer.