Brain Death Determination
Standards for death by neurologic criteria in adults ≥18 at AHS.
Updated: 07/13/2022
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⚠️ Review due 07/13/2025 — confirm with program leadership before use.
⚠️
Review Status: Next scheduled review was 07/13/2025. Confirm current with Dr. Mendoza before clinical use.
📋Prerequisites
▼- Irreversible and proximate cause established
- Drug screen: levels below therapeutic / 5× half-life cleared
- Blood alcohol <legal driving limit · no NMB agents
- No severe electrolyte/metabolic/endocrine disturbances
- Core temp ≥36°C · SBP ≥100 mmHg
- Labs: ABG, CBC, BMP, Osmolality, TSH/T4
💨Apnea Test Steps
▼1
Vasopressors → SBP ≥100
2
Preoxygenate ×10 min 100% O₂ → PaO₂ >200
3
Target PaCO₂ 35–45 · PEEP → 5 · SpO₂ >95% → baseline ABG
4
Disconnect vent — O₂ 6L/min via catheter to carina
5
Observe 8–10 min. Repeat ABG.
Positive: No respirations AND PaCO₂ ≥60 OR ≥20 mmHg rise. Abort if SBP <90 or SpO₂ <85% >30 sec.
ℹ️
Residents may perform exam only with attending directly supervising and attesting in all documentation.
- Status
- Needs Re-Review
- Source
- AHS_Brain_Death_Policy.pdf
- Last reviewed / updated
- 07/13/2022