Brain death diagnosis and management in the COVID-19 pandemic

Abstract

Purpose: This present study aimed to share experiences in the diagnosis and management of brain death (BD) and cadaveric donation cases, detected in a research hospital during the COVID-19 pandemic.
 Materials and Methods: BD cases diagnosed between 15/03/2020-15/05/2021 in our intensive care units (ICU) were retrospectively evaluated. Patients’ demographic characteristics, primary diagnoses, ICU admission time, and length of hospital stay were analyzed. Clinical suspicion, diagnosis, declaration, and donation or cardiac arrest times and supplementary tests to support the clinical judgment performed were also evaluated. 
 Results: 37 cases, were included in the study. Intracranial hemorrhage was the most common (54.1%) diagnosis in ICU admissions. Apnea tests could be performed only in 27 patients (73%). Cerebral CT-angiography was used as a supplementarytary test in 27 (73%) cases. Family consent for organ donation was obtained from 10 patients (27%), and 70% (n= 7) of them became donors. The time between ICU admission and BD diagnosis time was 114±92.8 (11-360) hours, the time between clinical suspicion and diagnosis was 32±15.1 (4-78) hours, the time between diagnosis and cardiac arrest of non-donors was 24±15.2 (5-72) hours, and the time between diagnosis and donation was 23±7.6 (15-35) hours.
 Conclusion: Occupancy in ICUs due to COVID-19 has reduced the admission of patients who may be donors to ICUs, and there has been a decrease in the number of BD detection, family approval, and organ donation in our hospital.

Retrospective Analysis of Patients Diagnosed with Brain Death in Our Hospital in the Last 15 Years

“…The primary disease causing permanent brain death in Türkiye has been identified as approximately 50–55% intracranial haemorrhage. [ 8 , 10 , 15 ] In Spain with 1844 cases and in Italy with 1286 cases, the primary disease causing death was found to be intracranial hemorrhage in 56% and 52%, respectively. [ 16 , 17 ] In the study literature, the primary disease of cases with brain death was found to be hemorrhagic cerebral damage in 47% of cases.…”

“…In studies conducted in Türkiye, the mean time between admission to intensive care unit and diagnosis of brain death was found to be 2.5–6 days. [ 9 , 10 , 15 , 23 ] In a study conducted in Europe, it was found between 2.5 and 7 days. [ 17 ] In our study, the mean time between admission to the intensive care unit and the diagnosis of brain death was found to be 6 days, consistent with the literature.…”

“…[ 24 ] In studies where confirmatory testing was used in diagnosing brain death in Türkiye, it was used in 30–70% of patients, and we see that CT angio was used most frequently. [ 8 , 10 , 15 ] Ancillary tests were used at a rate of 24% in Sweden and 95% in Spain. CT angio and EEG were used most frequently, [ 12 , 16 ] respectively.…”

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

“…118 Finally, a few publications addressed the challenges of apnea testing in patients with COVID-19, which was nonexistent when the WBDP was written. [115][116][117]119,120 Beyond Minimum Clinical BD/DNC Determination…”