New Guideline Updates Brain Death Determination for Adults and Children

In a significant development, the American Academy of Neurology (AAN) has released an updated guideline that redefines the criteria for determining brain death or death by neurologic criteria (BD/DNC). This comprehensive guideline is designed to encompass both adults and children, clarifying the process of BD/DNC determination in a single framework.

The primary objective of this guideline is to provide a much-needed revision to the 2010 AAN BD/DNC guideline for adults and the 2011 guideline for infants and children, issued by the American Academy of Pediatrics, Child Neurology Society, and Society of Critical Care Medicine. The revised guideline incorporates the latest advancements and medical practices, including the evaluation of BD/DNC in cases involving extracorporeal membrane oxygenation, targeted temperature management, and primary infratentorial injury.

The expert panel behind this guideline comprises members from various medical societies, and they relied on a unique evidence-informed consensus process due to the lack of high-quality evidence in this area. The panel used their extensive knowledge of BD/DNC literature to formulate preliminary recommendations. These recommendations underwent a rigorous vetting process involving a modified Delphi method, consistent with the 2017 AAN Clinical Practice Guideline Process Manual.

In total, the updated guideline encompasses 85 recommendations. These recommendations cover a wide range of crucial aspects related to BD/DNC evaluation, including general principles, qualifications for conducting BD/DNC evaluations, prerequisites for BD/DNC determination, components of the neurologic examination, apnea testing, ancillary testing, and special considerations for BD/DNC determination.

Ref: Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Guideline

Report of the AAN Guidelines Subcommittee, AAP, CNS, and SCCM

David M. Greer et al, Neurology Oct 2023, 10.1212/WNL.0000000000207740; DOI: 10.1212/WNL.0000000000207740