Author Response: Infratentorial Brain Injury Among Patients Suspected of Death by Neurologic Criteria: A Systematic Review and Meta-analysis

An Update on Brain Death/Death by Neurologic Criteria since the World Brain Death Project

“…76 Additionally, a 2021 systematic review and metaanalysis of 3,692 patients with suspected BD/DNC identified only 38 cases of isolated brainstem death (fulfillment of the clinical requirements for BD/DNC but preserved supratentorial blood flow, perfusion, or neurophysiologic function in the setting of infratentorial injury). 5 Follow-up data showed that 28 progressed to BD/DNC in accordance with the "whole brain" formulation, 5 continued to only meet criteria for BD/DNC in accordance with the "brainstem" formulation, and 5 were declared dead by circulatory-respiratory criteria without further ancillary testing.…”

“…Based on guidance from the WBDP, these data, a narrative review of the literature on the role of the reticular activating system and a narrative review of the literature on BD/DNC determination in the setting of primary infratentorial injury, including a survey that demonstrated the majority of Canadian intensivists would perform ancillary testing for BD/DNC determination in the setting of primary infratentorial injury, the 2023 Canadian BD/DNC guideline requires ancillary testing in this patient population. 1,4,5,[77][78][79] The 2023 AAN/AAP/CNS/SCCM BD/DNC guideline also provides special guidance about BD/DNC determination in patients with primary infratentorial injury, which was not included in the 2010 AAN BD/DNC guideline and the 2011 SCCM/AAP/CNS guideline. 32,80,81 However, this guidance differs from the WBDP recommendation, and simply notes that there should be evidence of catastrophic supratentorial injury on a conventional neuroimaging study.…”

“…2 Of the 192 publications that cited the WBDP, 4 were highly cited (top 1% of citations for field and publication year), 2 of which were the 2021 European Resuscitation Council and European Society of Intensive Care Medicine Guidelines on Post-resuscitation Care, which were co-published in Resuscitation and Intensive Care Medicine. 2,[4][5][6][7] Multiple other guidance and consensus statements related to neuroprognostication or organ donation cited the WBDP, including those written by the International Donation and Transplantation Legislative Policy Forum, the International Liaison Committee on Resuscitation, the Neurocritical Care Society, the Deutsche Gesellschaft für Neurointesnivmedizin, and the American Association for the Surgery of Trauma Critical Care Committee. [8][9][10][11][12] Although some citing publications focused on specific background content or recommendations, others more broadly reinforced the WBDP's goal to address controversies related to BD/DNC and improve international consistency.…”

Reader Response: Infratentorial Brain Injury Among Patients Suspected of Death by Neurologic Criteria: A Systematic Review and Meta-analysis

“…The article by Briard et al 1 affirmed that infratentorial brain injury is relatively uncommon among patients suspected of death by neurologic criteria (DNC) and that isolated brainstem death seems to progress to whole-brain death in most cases.…”