#Brain stem update

Only after it is clear that the patient will not likely recover should the brain stem reflex test and apnea test be conducted. To address this issue, these guidelines recommend that physicians wait an appropriate period of time, sufficiently long as is relevant to the individual patient's condition (in practice, usually several hours), after the onset of the brain insult to exclude the possibility of recovery, and requires that this possibility be ruled out prior to proceeding to the brain stem reflex exam.Īdding a waiting period early in the process – before the clinical assessment of brain death is initiated – provides greater assurance that there is little potential for improvement and is consistent with current clinical practice. Studies have since shown that there is insufficient evidence to pinpoint a minimally-acceptable number of hours to ensure that brain function has permanently ceased. The 2005 guidelines recommended an arbitrary waiting period of six hours and placed the waiting period between the first and second examinations of brain stem reflexes. Second, these updated guidelines, like the 2005 guidelines, include a waiting period to exclude the possibility of recovery, but differ in important ways from previous waiting period requirements. Accordingly, these updated guidelines contained in this document allow for an apnea test to be performed after a single, rigorous clinical examination showing that brain function has ceased. In addition, while waiting for a second assessment, patients are especially susceptible to cardiac arrest and vulnerable to rapid deterioration of other organ systems, which could lead to a needlessly prolonged confirmation of death. These delays have been shown to be traumatic to families watching their loved one in intensive care and waiting for confirmation of their death. In addition, conducting a second brain stem assessment within a reasonable timeframe is sometimes not possible, particularly in facilities that have only one physician who is privileged to perform brain death determinations. Extensive review of medical journals and studies conducted to date supports the use of a single proper brain function assessment after an appropriate waiting period, and an apnea test the results of which are diagnostic of brain death, in order to declare death. Evidence has revealed several disadvantages – and no concomitant benefits – to requiring the second brain stem assessment prior to the apnea test. First, the 2005 guidelines recommended two clinical assessments of brain stem reflexes before an apnea test was performed, whereas these guidelines recommend one comprehensive clinical assessment prior to an apnea test. These updated guidelines make two significant modifications to the 2005 guidelines, as well as a number of smaller changes to certain clinical parameters. Revisions to the 2005 Brain Death Determination Guidelines They also draw upon a consensus-building process that included ethical, legal and clinical review by the New York State Task Force on Life and the Law, as well as recommendations by an outside working group of expert physicians from across the State. They incorporate the guidelines of the American Academy of Neurology (AAN), initially released in 1995 and revised in 2010.

#Brain stem update

The guidelines contained in this document, which revise and update New York's 2005 guidelines, represent a broad consensus on the criteria for determining brain death. The Department of Health hopes that the issuance of these guidelines not only will help educate health care providers regarding such determinations, but also will increase the public's confidence that such determinations are made after a thorough and careful evaluation in accordance with accepted medical standards. This document provides guidance for determining brain death, aims to increase knowledge amongst health care practitioners about the clinical evaluation of brain death, and reduces the potential for variations in brain death determination policies and practices amongst facilities and practitioners within New York State. New York State Task Force on Life and the Law November 2011 Background Guidelines for Determining Brain Death is also available as a PDF.All Health Care Professionals & Patient Safety.Clinical Guidelines, Standards & Quality of Care.Health & Safety in the Home, Workplace & Outdoors.Birth, Death, Marriage & Divorce Records.