Confirmation of brain death diagnosis: A study on French practice

Abstract

Introduction: In France, brain death diagnosis is regulated by law and mandates the use of confirmatory tests (electroencephalogram or angiography). No data are available on this practice and the possible influence of medical history.

Study design: National survey using an e-mail questionnaire after phone agreement.

Patients and methods: A questionnaire was sent to intensive care units allowed to practice organ harvesting. It assessed the use of supplementary tests, the reasons behind the choice of a confirmatory test, as well as the influence of medical history on decision-making.

Results: Eighty-two out of 188 intensive care units (ICU) answered the questionnaire. Most of them (80%) performed supplementary tests, mainly transcranial Doppler. Computed tomography (CT) angiography was the only confirmatory test available in all ICUs, and this without interruption for 94% of them. Electroencephalogram (EEG) availability was usually restricted to weekdays. Most ICUs confirmed brain death by a CT-angiography (95%), less frequently by EEG (54%) and rarely by arteriography (12%). These tests were usually performed within 1 to 6 hours after clinical diagnosis. Results from imaging tests were obtained within 15 minutes in the majority of ICUs (59%), whereas the time for EEG results was more frequently between 15 and 60 minutes (62%). The choice of confirmatory test was guided by its availability (43%), or protocol driven (20%), or a combination of both of the latter criteria (35%). Medical history had no influence on this choice for 63% of respondents.

Discussion: CT-angiography is currently the privileged confirmatory test for the diagnosis of brain death in France. Availability is the main reason behind this choice. The EEG is the second most commonly used test. Transcranial Doppler helps to determine when to perform confirmatory tests.

Keywords: Brain CT-angiography; Brain death; Electroencephalogram; Survey; Transcranial Doppler.