Suitability of electroencephalography in brain death determination: a monocentric, 10-year retrospective, observational investigation of 428 cases.
Brain death
EEG
Transplantation
Journal
Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
ISSN: 1590-3478
Titre abrégé: Neurol Sci
Pays: Italy
ID NLM: 100959175
Informations de publication
Date de publication:
Apr 2023
Apr 2023
Historique:
received:
08
09
2022
accepted:
03
12
2022
pubmed:
13
12
2022
medline:
22
3
2023
entrez:
12
12
2022
Statut:
ppublish
Résumé
We aimed to verify the usefulness of electroencephalographic (EEG) activity recording (that is mandatory according to the Italian law), in addition to two clinical evaluations spaced 6 h, among the procedures of brain death determination (BDD) in adult individuals. The study is a monocentric, retrospective analysis of all BDDs performed in the last 10 years at Policlinico Le Scotte in Siena (Italy). Of the 428 cases revised (mean age 67.6 ± 15.03 years; range 24-92 years), 225 were males and 203 females. In total, 212 out of 428 patients (49.5%) were donors. None of the BDD procedures were interrupted due to the reappearance of EEG activity (neither for clinical reasons) at any sampling time, with the exception of one case that was considered a false negative at critical reinspection of the EEG. In 6/428 cases (1.4%), a cardiac arrest occurred during the 6 h between the first and second evaluation, thus missing the opportunity to take organs from these patients because the BDD procedure was not completed. Once the initial clinical examination before convening the BDD Commission has ascertained the absence of brainstem reflexes and of spontaneous breathing, and these clinical findings are supported by a flat EEG recording, the repetition of a 30-min EEG twice over a 6 h period seems not to add additional useful information to clinical findings. Current data, if confirmed in other centers and possibly in prospective studies, may help to promote a scientific and bioethical debate in Italy, as well as in other countries where the EEG is still mandatory, for eventually updating the procedures of BDD.
Sections du résumé
BACKGROUND
BACKGROUND
We aimed to verify the usefulness of electroencephalographic (EEG) activity recording (that is mandatory according to the Italian law), in addition to two clinical evaluations spaced 6 h, among the procedures of brain death determination (BDD) in adult individuals.
METHODS
METHODS
The study is a monocentric, retrospective analysis of all BDDs performed in the last 10 years at Policlinico Le Scotte in Siena (Italy).
RESULTS
RESULTS
Of the 428 cases revised (mean age 67.6 ± 15.03 years; range 24-92 years), 225 were males and 203 females. In total, 212 out of 428 patients (49.5%) were donors. None of the BDD procedures were interrupted due to the reappearance of EEG activity (neither for clinical reasons) at any sampling time, with the exception of one case that was considered a false negative at critical reinspection of the EEG. In 6/428 cases (1.4%), a cardiac arrest occurred during the 6 h between the first and second evaluation, thus missing the opportunity to take organs from these patients because the BDD procedure was not completed.
CONCLUSIONS
CONCLUSIONS
Once the initial clinical examination before convening the BDD Commission has ascertained the absence of brainstem reflexes and of spontaneous breathing, and these clinical findings are supported by a flat EEG recording, the repetition of a 30-min EEG twice over a 6 h period seems not to add additional useful information to clinical findings. Current data, if confirmed in other centers and possibly in prospective studies, may help to promote a scientific and bioethical debate in Italy, as well as in other countries where the EEG is still mandatory, for eventually updating the procedures of BDD.
Identifiants
pubmed: 36508079
doi: 10.1007/s10072-022-06547-1
pii: 10.1007/s10072-022-06547-1
pmc: PMC10023611
doi:
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1369-1373Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022. The Author(s).
Références
JAMA. 1968 Aug 5;205(6):337-40
pubmed: 5694976
Neurocrit Care. 2014 Dec;21(3):376-82
pubmed: 24865268
Clin Neurophysiol Pract. 2017 Aug 04;2:170-185
pubmed: 30214992
Stroke. 2003 Apr;34(4):1084-104
pubmed: 12677088
Rev Neurol (Paris). 1959 Jul;101:3-15
pubmed: 14423403
Neurophysiol Clin. 2015 Mar;45(1):97-104
pubmed: 25687591
J Cereb Blood Flow Metab. 1981;1(2):203-9
pubmed: 7328140
Handb Clin Neurol. 2019;161:89-102
pubmed: 31307622
Stroke. 1973 Jul-Aug;4(4):674-83
pubmed: 4723697
Intensive Care Med. 2007 Jan;33(1):9-10
pubmed: 17091242
Clin Neurophysiol. 2013 Dec;124(12):2362-7
pubmed: 23845894
Neurology. 2010 Jun 8;74(23):1911-8
pubmed: 20530327
Neurology. 2010 Jul 6;75(1):77-83
pubmed: 20603486
Neurocrit Care. 2009;11(2):276-87
pubmed: 19444652
J R Coll Physicians Lond. 1995 Sep-Oct;29(5):381-2
pubmed: 8847677