Abstract Details

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

Topic Neuro Trauma and Critical Care

Presentation(s) P14 - Poster Session 14 (11:45 AM-12:45 PM)

Poster/Presentation
Number 1-001

Objective The objective of this study was to assess the perceptions and approaches to death by neurological criteria (DNC) diagnosis among Canadian intensivists.

Background Trust in the deceased organ donation process relies on the expectation that the diagnosis of DNC is accurate and reliable. Ancillary tests are indicated to diagnose DNC whenever clinical neurological examination is unreliable or incomplete, but their use is variable and subject to debate.

Design/Methods We conducted a self-administered, online, cross-sectional survey of Canadian intensivists. Our sampling frame included all intensivists practicing in Canadian institutions. Results are reported using descriptive statistics.

Results Among 550 identified intensivists, 249 completed the survey. Respondents indicated they would be comfortable diagnosing DNC based on clinical criteria alone in cases where there is: movement in response to stimulation (48%); inability to evaluate upper/lower extremity responses (34%); presence of spontaneous peripheral movement (31%); inability to evaluate both oculocephalic and oculo-caloric reflexes (16%); presence of high cervical spinal cord injury (16%); and within 24 hours of hypoxemic-ischemic brain injury (15%). Most respondents agreed that an ancillary test should always be conducted when a complete clinical evaluation is impossible (93%), when there is possibility for a residual effect of sedative (89%), when the mechanism for brain injury is unclear (71%), and in the case of suspected isolated brainstem injury (59%). Sixty-six percent and 55% respectively believe that ancillary tests are sensitive and specific for DNC. Respondents consider the following ancillary tests useful for DNC: four-vessel conventional angiography (88%), nuclear imaging (75%), CT-angiography (65%) and CT-perfusion (56%).

Conclusions 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.

Authors/Disclosures
Joel Neves Briard, MD (Universite De Montreal) PRESENTER	Dr. Neves Briard has received research support from ��ɫ��.
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Shane English (The Ottawa Hospital)	No disclosure on file
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