• Brainstem death
    • Irreversible loss of consciousness with irreversible loss of capacity to breathe
      • Must be confirmed by two experienced, trained senior doctors
    • In certain countries 4 vessel angiogram, EEG, TCD and radioisotope scanning may be used
      • These are occasionally used in UK if conditions preclude testing (eg hypoxia, local CN lesions)
    • Preconditions
      • 2 doctors, trained, 5yrs registration with GMC
      • Pathology for irreversible brain damage must be identifiable
      • Patient must be unresponsive. No consideration that it is due to sedatives, hypothermia, or reversible circulatory, metabolic or endocrine problems.
      • Apnoeic requiring mechanical ventilation, with the possibility of NMBDS excluded
      • Effects of narcotics/hypnotics excluded
      • Na⁺ 115-160
      • BM 3-20
      • Mg²⁺/PO⁴⁻ 0.5-3.0
      • K⁺ > 2.0
      • Temp >34
      • PaO₂ >10kPa
      • MAP >60mmHg
      • Death at end of 1st set of tests
    • Testing
      • Pupils fixed with no direct or consensual response to light (II & III)
      • No corneal reflex on stimulation (V & VII)
      • No motor response within CN distribution in response to stimulation in any somatic area. No limb response to supra-orbital pressure. (V & VII)
      • Vestibulo-ocular reflexes ascent on calorific testing. TM tested for wax, head flexed to 30 degrees, and 50ml of ice cold water instilled over 1 min. (VIII & III)
      • No gag reflex (IX & X)
      • No cough with carinal stimulation (X & X)
      • Apnoea testing
        • No respiratory movements when disconnected from the vent. Pre-oxygenate, and allow the PaCO₂ to rise to 6.0 prior to disconnection. Hypoxia is avoided by oxygen insufflation through a catheter in the ETT. The pCO₂ should rise to 6.65 on the ABG.
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/early/2012/05/23/bjaceaccp.mks026.full.pdf
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/4/3/86.full.pdf
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/early/2011/03/15/bjaceaccp.mkr008.full.pdf