Use cerebral CT angiography to support clinical diagnosis of death using neurological criteria: Consensus statement

The recommendations are given below:

• Ancillary investigation is required in the following circumstances:
• a comprehensive neurological examination, including the apnea test, is not possible; and/or
• continuing effects of confounding conditions cannot be excluded.
• Ancillary investigation should be considered in the following additional circumstances:
• uncertainty regarding the interpretation of possible spinally mediated movements; and/or
• to promote understanding of the clinical confirmation of death using neurological criteria to families who are uncertain or unaccepting of such a diagnosis.
• Requests for cerebral CT angiography must be made by direct discussion between the treating intensive care consultant and radiology consultant. It should be made clear that the request is to support the clinical diagnosis of death using neurological criteria.
• Cerebral CT angiography becomes the standard ancillary investigation of choice for supporting the diagnosis of death using neurological criteria in the UK.
• A clinical diagnosis of death using neurological criteria cannot be supported if the cerebral CT angiogram demonstrates contrast opacification of any of the vessels specified in the four-point criteria.
• The process of diagnosing death using neurological criteria should be guided and documented using the forms for adults endorsed by the Faculty of Intensive Care Medicine and Intensive Care Society and the paediatric versions endorsed by the Royal College of Paediatrics and Child Health and Paediatric Critical Care Society.
• A system of auditing national practice on the use and outcomes of ancillary investigations to support a clinical diagnosis of death using neurological criteria should be established. We suggest that this is done by inclusion into the potential donor audit, which already collects data on all patients in the UK in whom a diagnosis of death using neurological criteria is undertaken.
• There is insufficient evidence to make a consensus recommendation for using cerebral CT angiography as an ancillary investigation to support the clinical diagnosis of death using neurological criteria in patients receiving extracorporeal membrane oxygenation.
• There is insufficient evidence to make a consensus recommendation for using cerebral CT angiography as an ancillary investigation to support the clinical diagnosis of death using neurological criteria in paediatrics. Where cerebral CT angiography is used, it should be reported by a neuroradiologist experienced in paediatrics. Ancillary investigations should not be used in infants aged < 2 months.