Brain Death

Clinicians who work in neurointensive care units must be familiar with brain death/death by neurologic criteria (BD/DNC). To declare BD/DNC, a patient must be in a permanent coma due to a known etiology, have brainstem areflexia, and be unable to breathe spontaneously in the setting of a hypercarbic acidemic challenge. The presence of confounders must be excluded, and the standardized examination must be performed accurately to prevent false-positive determinations of death. It is imperative that clinicians involved in BD/DNC evaluations be adept at communicating with families/legally authorize representatives about BD/DNC. The goals of this chapter are (1) Examine the etiologies for BD/DNC; (2) review techniques for successful communication with families/LARs about BD/DNC; (3) identify the prerequisites to perform an evaluation for BD/DNC; (4) review performance of a clinical evaluation for BD/DNC; (5) summarize the assessment for apnea; and (6) examine the indications for, and interpretation of, ancillary testing.