What are the preconditions for Brain-stem Death testing?
The patient must have a GCS of E1V1M1 and be mechanically ventilated with apnoea
Proof that the patient’s condition is due to irreversible, structural brain damage
2 doctors of sufficient clinical experience to perform brain-stem testing. One should be a consultant, the other should be qualified with full GMC registration for a minimum of 6 years
Exclusion of reversible causes of coma satisfied by each of the two doctors carrying out the brain-stem testing
Residual effects of sedative drugs or toxins – may require plasma level measurements
Residual neuromuscular blockade – can be tested for using peripheral nerve stimulation if required
Hypotension: Mean Arterial Pressure should be > 60 mmHg in the hours prior to testing for adults
Hypothermia: Core body temperature must be ³ 34°C
Hypo/Hypernatraemia: Serum Na+ levels must be between 115-160 mmol/L – rapid changes should also be avoided
Hypokalaemia: Serum K+ should be > 2 mmol/L
Severe Hypo/Hyperphosphataemia: Serum PO4- should be between 0.5-3.0 mmol/L
Severe Hypo/Hypermagnesaemia: Serum Mg2+ Should be between 0.5-3.0 mmol/L
Hypo/Hyperglycaemia: Blood Glucose should be between 3.0-20.0 mmol/L
When endocrine disturbance is suspected hormonal assays should be undertaken
The patient is older than 2 months of age. Separate guidance exists for infants from 37 weeks corrected gestational age to 2 months old. Brain-stem testing is not suitable for infants below this age. Out of the two doctors performing brain-stem testing in children should also ideally be a paediatrician and one should not be primarily involved in the child’s care [6].
