Brain drain: using the deep venous system to declare brain death.

摘要

The neurological determination of death or brain death is accepted in Canada and many countries as proof of death of the individual. This allows for the mandatory discontinuation of "life support measures" (ventilators, blood pressure control, hormonal supplements and warming techniques) and the transplantation of organs if consent is obtained. The "gold standard" is the clinical assessment and must fulfill the following criteria: the cause must be known and the etiology must be capable of causing neuronal death, the cranial nerve reflexes are absent, there are no brain-originating movements that are either spontaneous or evoked and apnea is assured with a reliable technique. Certain caveats apply: testing must be done after 24 hours in cases of cardiac arrest, the core temperature should be 34degC or greater, and there should not be any confounders such as: unresuscitated shock, severe metabolic disorders capable of causing a potentially reversible coma, peripheral nerve or muscle dysfunction or neuromuscular blockade potentially accounting for unresponsiveness or clinically significant drug intoxications (e.g., alcohol, bar-biturates, sedatives or hypnotics).