Complications associated with the apnea test in the determination of the brain death

Background An apnea test is essential in the clinical determination of brain death. This study was conducted to analyse complications associated with the apnea test in the determination of the brain death. Methods On 93 adult patients in coma in Zhejiang Province of China from January 2003 to December 2006, 179 apnea tests were performed as a part of the determination of brain death. Potential risk conditions and complications were analysed during apnea tests. Results During apnea, serious cardiac arrhythmia did not occur in all patients. Complications occurred in 37 of 179 （21%） apnea tests. Hypotension occurred in 30 patients （17%） and it was observed in 8/94 （9%） tests with baseline value of systolic arterial blood pressure not less than 120 mmHg, and 22/85 （26%） less than 120 mmHg （P 〈0.05）. Severe hypoxaemia occurred in 10 patients （6%） of which 3/138 （2%） tests with baseline value of arterial oxygen pressure not less than 200 mmHg, and 7/41 （17%） less than 200 mmHg （P 〈0.05）. Conclusions This study demonstrated that complications occurred mostly in patients with inadequate baseline systolic arterial blood pressure and preoxygenation. Adequate precautions during the apnea tests may reduce the risk of cardiovascular and oxygenation complication.

A Comparison of Brain Death Criteria between China and the United States

Background： Criteria for determining brain death （BD） vary between China and the United States. We reported the results of an investigation designed to compare procedures to determine BD in two countries. Methods： The latest criteria in the United states were published in 2010. The latest criteria in China were published in 2009. We used these two types of BD criteria to evaluate patients who were considered to be BD. The time, cost, and accuracy of the diagnosis were compared. Results： From January 1, 2012 to October 8, 2013, there were 37 patients which were applied for BD evaluation in the Neurological Intensive Care Unit of Beijing Tiantan Hospital. The cause of coma were known as subarachnoid hemorrhage （18 patients, 48.6%）, intracerebral hemorrhage （8 patients, 21.6%）, cerebral ischemia （9 patients, 24.3%）, brain stem tumor （1 patient, 2.7%）, and intracranial infection （1 patient, 2.7%）. The clinical examinations were done for all of the patients except 1 patient who had low blood pressure. Three patients had hrainstem reflexes that were excluded from BD. Twenty-five patients had apnea tests, and 20 tests were completed that were all positive. Confirmatory tests were completed differently： Transcranial Doppler （30 patients, positive rate 86.7%）, electroencephalogram （25 patients, positive rate 100%）, and somatosensory evoked potential （16 patients, positive rate 100%）. Thirty-three patients were diagnosed BD by criteria of the United States. Only 9 patients were diagnosed BD by Chinese criteria. The use of time and money in the USA criteria was obviously fewer than those in Chinese criteria （P = 0.000）. Conclusion： Compared with BD criteria of the United States, Chinese criteria were stricter, lower positive rate, more cost in money and time, and more reliable by families and doctors.

Apparently Recovering Breath Function in Brain Death

Brain death （BD） is that someone＇s brain stops functioning, even though their heart may be kept beating using a machine. After brain function had ceased, somatic function being sustained by mechanical ventilation tbr a long time. Further treatment is inappropriate in a dead patient. Hence, in many countries, the law provides that treatment can be legitimately removed from a patient who was diagnosed BD and the donation of organs for transplantation can start.