Clinical course and determination of brainstem death in a children's hospital

• Published in: Acta Paediatrica Vol. 93; no. 1; pp. 47 - 52
• Main Authors: Goh, AY-T, Mok, Q
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.01.2004; Blackwell
• Subjects: Adolescent; Age Distribution; Biological and medical sciences; Brain Death - physiopathology; Brainstem death; Cardiopulmonary Resuscitation; Child; Child, Preschool; children and ancillary tests; clinical criteria; Craniocerebral Trauma - physiopathology; Craniocerebral Trauma - therapy; Errors of metabolism; Female; General aspects; Hospital Mortality; Humans; Infant; Infant, Newborn; Intensive Care Units, Pediatric; Lipids (lysosomal enzyme disorders, storage diseases); Male; Medical sciences; Metabolic diseases; Retrospective Studies; Human; Pediatrics; children and ancillary tests; Brain stem; Mortality; Central nervous system; Exploration; Determination; clinical criteria; Encephalon; Criterion; Brainstem death; Death; Hospital; Child
• ISSN: 0803-5253; 1651-2227
• DOI: 10.1111/j.1651-2227.2004.tb00673.x

Aim: To study the aetiology and clinical course of children with brainstem death in a paediatric intensive care unit (ICU) and to determine whether current the practices that are used to declare brainstem death conform to accepted criteria. Methods: A retrospective review chart of all patients with brainstem death (n= 31) admitted to the paediatric ICU between January 1995 and December 1998 was drawn up. Results: Mean age of the patients was 51.9 ± 54.5 mo with the main diagnoses being head trauma in 11 children, anoxic encephalopathy in 7, brain tumour in 5, drowning in 4, CNS haemorrhage in 3 and CNS infection in 1 child; 32.3% of the children were given pre‐ICU admission cardiopulmonary resuscitation. The average time from insult to suspected brainstem death was 27 h and suspected brainstem death to confirmation was 25 h, with an average of 1.6 examinations performed. EEG was done in 14 patients, with electrocerebral silence in 8 after the first examination and in a further 5 after repeat testing. Cerebral blood‐flow scans were done in 3 children and evoked potentials in 1 child. Conclusions: Trauma remains the most common primary diagnosis leading to brainstem death. Intensivists in this large hospital for children mainly conform to accepted guidelines for determination of brainstem death although there is a wider use of ancillary tests to aid diagnosis. The study also showed a low rate of < 10% of organ procurement for transplantation.