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P.050 Perspectives on the use of ancillary tests for determining neurological death: a survey of Canadian intensivists

Published online by Cambridge University Press:  05 January 2022

J Neves Briard
Affiliation:
(Montreal)*
M Yu
Affiliation:
(Montreal)
LP Carvalho
Affiliation:
(Montreal)
SW English
Affiliation:
(Ottawa)
F d’Aragon
Affiliation:
(Sherbrooke)
F Lauzier
Affiliation:
(Quebec)
A Turgeon
Affiliation:
(Quebec)
S Dhanani
Affiliation:
(Ottawa)
L McIntyre
Affiliation:
(Ottawa)
SD Shemie
Affiliation:
(Montreal)
G Knoll
Affiliation:
(Ottawa)
DA Fergusson
Affiliation:
(Ottawa)
SJ Anthony
Affiliation:
(Toronto)
MJ Weiss
Affiliation:
(Quebec)
M Chassé
Affiliation:
(Montreal)
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Abstract

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Background: Ancillary tests are indicated to diagnose death by neurological criteria whenever clinical neurological examination is unreliable, but their use is variable and subject to debate. Methods: Survey of Canadian intensivists providing care for potential organ donors. We included closed-ended questions and different clinical scenarios regarding the use of ancillary tests. Results: Among 550 identified intensivists, 249 completed the survey. Respondents indicated they would be comfortable diagnosing death based on neurological examination without ancillary tests in the following scenarios: movement in response to stimulation (48%), spontaneous peripheral movement (31%), inability to evaluate upper/lower extremity responses (34%) or both oculocephalic and oculo-caloric reflexes (17%), presence of high cervical spinal cord injury (16%) and within 24 hours of hypoxemic-ischemic brain injury (15%). Furthermore, 93% agreed that ancillary tests should always be conducted when a complete neurological examination is impossible, 89% if there remains possibility of residual sedative effect and 59% in suspected isolated brainstem death. Conclusions: Our findings suggest that Canadian intensivists have different perceptions on what constitutes a complete and reliable clinical neurological examination for determining death by neurologic criteria. Some self-reported practices also diverge from national recommendations. Further investigation and education are required to align and standardize medical practice across physicians and systems.

Type
Poster Presentations
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation