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Brainstem death
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- 2. Brainstem Death Moment of death “Physiologicaldecapitation” - Christopher Pallis
- 3. In whom it is applicable ? Thosewho on artificial life support systems Those who are awaiting for organ donation for transplant
- 4. Brainstem death - Importance When thisis proved, patients is dead Discontinue mechanical life support Removal of organs for transplantation can be done
- 5. How to diagnose? Pre-conditions • Causefor unconsciousness is not due to reversible causes • Cause for irreversible cessation of spontaneous respiration is not due to drugs Clinical criteria • Absent brainstem reflexes • Absent motor response • Apnoea tests
- 6. Cause for unconsciousn ess isnot due to reversible causes EXCLUDE • Drug overdose ( e.g.- Benzodiazepine, opiates) • Hypothermia • Metabolic disorders • Severe electrolyte abnormalities • Endocrine disorders There has to be • A natural or traumatic • Gross disrupting lesion • Of brain or brainstem • Sufficient to loss of consciousness
- 7. Cause of irreversible spontaneous respiratory cessation is notdue to drugs Eg- suxamethonium – muscle paralysis
- 8. Clinical criteria Absent brainstem reflexes Absentmotor response Apnoea test
- 9. Absent Brainstem Reflexes Pupillary reflex Cornea reflex Vestibulo-ocularreflex Gag reflex Oculo-cephalic reflex
- 10. Pupillary reflex Direct a bright light into each eye Observ e for at least 60 sec Pupils - Fixed No reaction to light Absent reflex
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- 12. Corneal Reflex Gently touch the cornea witha sterile cotton wool Eyes do not blink Absent reflex
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- 14. Vestibulo- ocular reflex Inject cold water to auditory meatus Eyesdo not move towards the irrigated ear Absent reflex
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- 16. Gag reflex Stimulate the larynxand trachea with a rubber catheter No cough Absent reflex
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- 18. Oculo- cephalic reflex Grasp the patient’shead between your hands Elevate eye lids using thumbs Rapidly move head side to side through 180 degrees Eyes move with the head Eyes do not move within the orbit
- 20. Absent of motor responses No motorresponse by stimulating somatic area of cranial nerve distribution No limb response to supra orbital pressure
- 21. Apnoea test Ventilate 100% oxygenfor 10 mins Ventilate 5% carbon dioxide for 5 mins Disconnect ventilator for 10 mins Repeat the test in2-4 hours No decerebrate rigidity nor seizure Persistence of apnoea
- 22. Apnoea test should be done Twice Byone doctor at each time • At least one consultant ( preferably anaesthesiologist in charge of the patient) • Other one not in the transplant team or harvesting team • Both should be registered doctors for at least 5 years • Competent doctors At an interval of 2 hours Both times same result Both doctors should confirm the brainstem death
- 23. When brainstem death is confirmed Disconnect theartificial life support If the organs are to be harvested for transplant, proceed accordingly
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