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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2013 May;79(5):485-91
Current practice of brain death determination and use of confirmatory tests in an Italian University hospital: a report of 66 cases
Vicenzini E. 1, Pro S. 1, Pulitano P. 1, Rocco M. 2, Spadetta G. 2, Zarabla A. 1, Di Piero V. 1, Mecarelli O. 1 ✉
1 Department of Neurology and Psychiatry, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy;
2 Intensive Care Unit, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
Background: Time to final brain death (BD) determination is fundamental to rapidly identify donors without organ deterioration. Guidelines for BD determination are different from country to country and, through years, they have been subjected to several revisions, to simplify the procedure. The aim of this study was to describe a one-year experience according to the latest Italian Guidelines for BD in our University hospital and to focus on timing of final BD declaration according to the ancillary tests executed.
Methods: Sixty-six consecutive inpatients with BD diagnosis were enrolled. Etiological factors, ancillary tests and timing to final declaration were analyzed.
Results: Electroencephalogram (EEG) could be performed without artifacts in all the patients. Time to BD procedure starting depended on whether the demonstration of cerebral circulatory arrest was required, being shorter with EEG only (40±17 min), longer with cerebral blood flow evaluation (175±95 min), minimal with transcranial Doppler (83±32 min), maximal with angiography (165±20 min). None of the patients who initiated BD procedure were found to recover cerebral or brainstem function at the second observation.
Conclusions: In Italy, the same guidelines ensure the same approach in every hospital, with multi-specialist cooperation. The EEG is mandatory and prompt recognition of the first, flat EEG is fundamental to reduce time to the final procedure. A multimodal neurophysiological approach with trained specialists, neurosonologists and monitoring devices in intensive care units may represents a valid help to further reduce time for BD diagnosis.