Brain Death/Death by Neurologic Criteria Determination

Ariane Lewis, M.D; Matthew P. Kirschen, M.D, PhD

2021년 10월 1일

Continuum (Minneap Minn). 2021Oct 1;27(5):1444-1464.

DOI: 10.1212/CON.0000000000000987

Abstract

Purpose of review: This article describes the prerequisites for brain death/death by neurologic criteria (BD/DNC), clinical evaluation for BD/DNC (including apnea testing), use of ancillary testing, and challenges associated with BD/DNC determination in adult and pediatric patients.

Recent findings: Although death determination should be consistent among physicians and across hospitals, states, and countries to ensure that someone who is declared dead in one place would not be considered alive elsewhere, variability exists in the prerequisites, clinical evaluation, apnea testing, and use of ancillary testing to evaluate for BD/DNC. Confusion also exists about performance of an evaluation for BD/DNC in challenging clinical scenarios, such as for a patient who is on extracorporeal membrane oxygenation or a patient who was treated with therapeutic hypothermia. This prompted the creation of the World Brain Death Project, which published an international consensus statement on BD/DNC that has been endorsed by five world federations and 27 medical societies from across the globe.

Summary: The World Brain Death Project consensus statement is intended to provide guidance for professional societies and countries to revise or develop their own protocols on BD/DNC, taking into consideration local laws, culture, and resource availability; however, it does not replace local medical standards. To that end, pending publication of an updated guideline on determination of BD/DNC across the lifespan, the currently accepted medical standards for BD/DNC in the United States are the 2010 American Academy of Neurology standard for determination of BD/DNC in adults and the 2011 Society of Critical Care Medicine/American Academy of Pediatrics/Child Neurology Society standard for determination of BD/DNC in infants and children.

Prerequisites for Brain Death/Death by Neurologic Criteria

Clinical Examination/Examiner Specifications for Brain Death/Death by Neurologic Criteria

Apnea Testing for Brain Death/Death by Neurologic Criteria

Ancillary Testing for Brain Death/Death by Neurologic Criteria

Communication About Brain Death/Death by Neurologic Criteria

요약

·         소개 : 이 논문은 뇌사 또는 신경학적 기준에 의한 사망(BD/DNC)을 판정하는 데 필요한 조건, 임상 평가(무호흡 검사 포함), 보조 검사(Ancillary Test)의 사용, 그리고 성인 및 소아에서의 판정과 관련된 도전 과제들을 설명한다.

·         최신동향 : 뇌사 판정은 전 세계적으로 일관되어야 하지만, 실제로는 의사, 병원, 지역, 국가 간에 기준과 절차가 다르다. 특히 무호흡 검사, 보조 검사의 사용, 특정 임상 상황(예: ECMO 치료 중인 환자, 저체온 치료 중인 환자)에서 혼란이 발생하고 있다. 이런 문제를 해결하기 위해 World Brain Death Project가 발족되었고, 5개 세계 연맹과 27개 의학 학회의 지지를 받은 국제 합의 성명서를 발표했다.

·         결론 : 국제 합의문은 각국의 법률, 문화, 자원 상황을 고려해 자국의 뇌사 판정 프로토콜을 개발하거나 수정하는 데 참고하도록 설계되었으며, 현지의 의료 기준을 대체하지는 않는다. 미국에서는 아직 새로운 가이드라인이 발표되기 전까지, 아래 두 가지 기준이 유효하다:

-성인: 2010년 미국신경과학회(AAN) 기준

-소아 및 영아: 2011년 중환자치료학회(SCCM), 미국소아과학회(AAP), 소아신경학회(CNS) 기준