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Computed Tomography Angiography (CTA) in Selected Scenarios with Risk of Possible False-Positive or False-Negative Conclusions in Diagnosing Brain Death. LIFE (BASEL, SWITZERLAND) 2022; 12:life12101551. [PMID: 36294986 PMCID: PMC9604663 DOI: 10.3390/life12101551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
It is widely accepted that brain death (BD) is a diagnosis based on clinical examination. However, false-positive and false-negative evaluation results may be serious limitations. Ancillary tests are used when there is uncertainty about the reliability of the neurologic examination. Computed tomography angiography (CTA) is an ancillary test that tends to have the lowest false-positive rates. However, there are various influencing factors that can have an unfavorable effect on the validity of the examination method. There are inconsistent protocols regarding the evaluation criteria such as scoring systems. Among the most widely used different scoring systems the 4-point CTA-scoring system has been accepted as the most reliable method. Appropriate timing and/or Doppler pre-testing could reduce the number of possible premature examinations and increase the sensitivity of CTA in diagnosing cerebral circulatory arrest (CCA). In some cases of inconclusive CTA, the whole brain computed tomography perfusion (CTP) could be a crucial adjunct. Due to the increasing significance of CTA/CTP in determining BD, the methodology (including benefits and limitations) should also be conveyed via innovative electronic training tools, such as the BRAINDEXweb teaching tool based on an expert system.
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Saad T. Eugène Bouchut's (1818-1891) Early Anticipation of the Concept of Brain Death. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2022; 47:407-423. [PMID: 35880590 DOI: 10.1093/jmp/jhac002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The conventional historical account of the concept of brain death credits developments and discoveries of the twentieth century with its inception, emphasizing the role of technological developments and professional conferences, notably the 1968 Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. This essay argues that the French physician Eugène Bouchut anticipated the concept of brain death as early as 1846. Correspondence with Bouchut's understanding of brain death and one important contemporary concept of brain death is established then contrasted with current trends of defining death as the death of the brain. The philosophical factors that influenced Bouchut and the later developments of concepts of brain death are considered, with special reference to mechanistic philosophy and vitalism.
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Affiliation(s)
- Toni Saad
- Gloucestershire Royal Hospital, Gloucester, United Kingdom
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3
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Perioperative management of the organ donor after diagnosis of death using neurological criteria. BJA Educ 2021; 21:194-200. [PMID: 33927892 DOI: 10.1016/j.bjae.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/03/2021] [Indexed: 11/19/2022] Open
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4
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Gardiner D, Charlesworth M, Rubino A, Madden S. The rise of organ donation after circulatory death: a narrative review. Anaesthesia 2020; 75:1215-1222. [PMID: 32430909 DOI: 10.1111/anae.15100] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 11/29/2022]
Abstract
Solid organ transplantation saves and transforms lives. The original type of organ donation from deceased patients was controlled donation after circulatory death, previously referred to as non-heart beating organ donation. The rise of donation after circulatory death in the UK came about through advances in critical care and transplant medicine and support from several key organisations in developing a robust ethical, legal and professional framework. The transplant waiting list reached a historic peak in 2009-2010 of 8000 patients, but fell by 25% to 6000 in 2017-2018. There has also been a steady rise in the number of deceased donors and the number of donations after circulatory death. The contribution of donation after circulatory death to the total number of donations rose steadily between 2000 and 2012 and has remained about 40% since. Although the situation has improved for patients waiting for a transplant, deaths and long waits remain common. Changes to legislative, technical and peri-mortem procedures may greatly change future practices in donation after circulatory death in the UK.
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Affiliation(s)
- D Gardiner
- National Clinical Lead for Organ Donation, NHS Blood and Transplant, Nottingham, UK
| | - M Charlesworth
- Department of Cardiothoracic Anaesthesia, Critical Care and ECMO, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - A Rubino
- Department of Cardiothoracic Anaesthesia, Critical Care and ECMO, Royal Papworth Hospital, Cambridge, UK
| | - S Madden
- NHS Blood and Transplant, Bristol, UK
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5
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Maguire A. Towards a holistic definition of death: the biological, philosophical and social deficiencies of brain stem death criteria. New Bioeth 2019; 25:172-184. [PMID: 31130114 DOI: 10.1080/20502877.2019.1606148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
With no statutory definition of death, the accepted medical definition relies on brain stem death criteria as a definitive measure of diagnosing death. However, the use of brain stem death criteria in this way is precarious and causes widespread confusion amongst both medical and lay communities. Through critical analysis, this paper considers the insufficiencies of brain stem death. It concludes that brain stem death cannot be successfully equated with either biological death or the loss of integrated bodily function. The overemphasis of the brain-stem and its consequences leaves the criteria open to significant philosophical critique. Further, in some circumstances, the use of brain stem death criteria causes substantial emotional conflict for families and relatives. Accordingly, a more holistic and comprehensive definition of death is required.
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Affiliation(s)
- Abigail Maguire
- a Institute of Theology , St Mary's University , Twickenham , UK
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Mitre C, Mitre I. Diagnosing "Brain Death" in Intensive Care. J Crit Care Med (Targu Mures) 2017; 3:128-130. [PMID: 29967885 PMCID: PMC5769896 DOI: 10.1515/jccm-2017-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Călin Mitre
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ileana Mitre
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
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7
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Pathirana J, Muñoz FM, Abbing-Karahagopian V, Bhat N, Harris T, Kapoor A, Keene DL, Mangili A, Padula MA, Pande SL, Pool V, Pourmalek F, Varricchio F, Kochhar S, Cutland CL. Neonatal death: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2016; 34:6027-6037. [PMID: 27449077 PMCID: PMC5139812 DOI: 10.1016/j.vaccine.2016.03.040] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/15/2016] [Indexed: 12/20/2022]
Abstract
More than 40% of all deaths in children under 5 years of age occur during the neonatal period: the first month of life. Immunization of pregnant women has proven beneficial to both mother and infant by decreasing morbidity and mortality. With an increasing number of immunization trials being conducted in pregnant women, as well as roll-out of recommended vaccines to pregnant women, there is a need to clarify details of a neonatal death. This manuscript defines levels of certainty of a neonatal death, related to the viability of the neonate, who confirmed the death, and the timing of the death during the neonatal period and in relation to immunization of the mother.
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Affiliation(s)
- Jayani Pathirana
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa; Department of Science and Technology, National Research Foundation, Vaccine Preventable Diseases, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Flor M Muñoz
- Departments of Pediatrics, Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | | | - Niranjan Bhat
- Program for Appropriate Technology in Health (PATH), Seattle, USA
| | - Tara Harris
- Immunization and Vaccine Preventable Diseases, Public Health Ontario, Canada
| | - Ambujam Kapoor
- Immunization Technical Support Unit - Ministry of Health and Family Welfare, Public Health Foundation of India, New Delhi, India
| | - Daniel L Keene
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | | | - Michael A Padula
- Division of Neonatology, The Children's Hospital of Philadelphia and University of Pennsylvania, USA
| | - Stephen L Pande
- Ministry of Health Uganda, Soroti Regional Referral Hospital, Uganda
| | | | - Farshad Pourmalek
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | | | | | - Clare L Cutland
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa; Department of Science and Technology, National Research Foundation, Vaccine Preventable Diseases, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Kongsgaard UE, Steen PA. Lasarus-fenomenet. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014; 134:1257-9. [DOI: 10.4045/tidsskr.14.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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9
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Gray LD, Morris CG. Organisation and planning of anaesthesia for emergency surgery. Anaesthesia 2013; 68 Suppl 1:3-13. [PMID: 23210552 DOI: 10.1111/anae.12054] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Patients presenting for emergency surgery represent a category at high risk of complications, with substantial morbidity and mortality, whose management may be extremely challenging. In this first of two articles we consider the identification and evaluation of high risk emergency patients, the provision of critical care support, the management of sepsis, common postoperative complications and in-theatre death.
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Affiliation(s)
- L D Gray
- Department of Anaesthesia and Intensive Care Medicine, Queen's Medical Centre, Nottingham, UK
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