Вказівки щодо визначення загибелі головного мозку / смерті за неврологічними критеріями в пацієнтів віком ≥ 37 тижнів*†

All 8 items must be confirmed to declare brain death:

1. Cause of coma is known, catastrophic, and sufficient to account for irreversible and permanent loss of all brain function.

2. CNS depressant medications and illicit drugs; metabolic, acid-base, and electrolyte disorders; hypothermia (< 36° C); and hypotension (mean arterial pressure < 75 mm Hg) have been excluded. No neuromuscular blockers contribute to the neurologic findings.

3. The patient is comatose and not responsive to visual, auditory, and tactile stimulation. Any observed movements can be attributed entirely to spinal cord reflexes.

4. The cough reflex, pharyngeal (gag) reflex, or both are tested and shown to be absent.

5. Corneal and pupillary light responses are absent bilaterally.

6. Bilateral oculocephalic reflex testing that shows fixed eye movement with rotation of the head and caloric vestibulo-ocular reflex testing and that shows no caloric response after ice water is applied to the tympanic membrane must be demonstrated.

7. An apnea test is done.

PROCEDURE: Before the apnea test, 100% oxygen is given for ≥ 10 minutes. Arterial blood gas testing is done to document a PaCO2 of 35–45 mm Hg and a pH of 7.35–7.45. If the patient is known to have chronic hypercarbia, the PaCO2 level used should be the patient's baseline. Apnea testing is then done by disconnecting the ventilator from the endotracheal tube. Oxygen (4–6 L/min) can be supplied by diffusion from a cannula placed through the endotracheal tube. Despite the ventilatory stimulus of the passively rising PaCO2, brain death requires the absence of spontaneous respirations, a pH of < 7.30, and a PaCO2 of ≥ 60 mm Hg and ≥ 20 mm Hg above the patient's baseline.

NOTE: The apnea test should be done with extreme caution to minimize risks of hypoxia and hypotension, particularly in potential organ donors. The test should be stopped and arterial blood samples drawn if any of the following occurs during the test:

• Arterial BP falls significantly (systolic BP < 100 mm Hg, or mean arterial pressure < 75 mm Hg).

• Oxygen saturation is < 85%.

• Cardiac arrhythmias develop.

The apnea testing procedures can be used in patients receiving extracorporeal membrane oxygenation.

8. At least 1 of the following 4 criteria has been established:

1. a. Items 2–7 have been confirmed.

1. b. Items 2–7 have been confirmed AND (done when components of the examination or apnea testing cannot be completed or when results of the examination are uncertain)

   • An EEG shows electrocortical silence.

1. c. Items 2–7 have been confirmed AND (done when components of the examination or apnea testing cannot be completed or when results of the examination are uncertain)

   • Conventional angiography, transcranial Doppler ultrasonography (to be used only in adults; not yet validated in children), or technetium-99m hexamethylpropyleneamine oxime brain scanning shows no intracranial blood flow.

1. d. If any of items 2–7 cannot be determined because the injury or condition prohibits evaluation (eg, extensive facial injury precludes caloric testing), the following criteria apply:

   • Items that are assessable are confirmed.

   • Conventional angiography, transcranial Doppler ultrasonography (to be used only in adults; not yet validated in children), single-photon emission computed tomography (SPECT), or technetium-99m hexamethylpropyleneamine oxime brain scanning shows no intracranial blood flow or an EEG shows no cortical activity.