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Diagnostico de muerte cerebral(1)

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Brain death and organ donation
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Diagnostico de muerte cerebral(1)

  1. 1. *La ME se define como el cese irreversible en las funciones de todas las estructuras neurológicas intracraneales, tanto de los hemisferios cerebrales como del troncoencéfalo. *Esta situación clínica aparece cuando la presión intracraneal (PIC) se eleva por encima de la presión arterial sistólica (PAS) del paciente, lo que da lugar a la parada circulatoria cerebral.
  2. 2. *The Canadian forum on NDD defined neurologically determined death as the irreversible loss of the capacity for consciousness combined with the irreversible loss of all brain stem functions, including the capacity to breathe. *In the United States, the Uniform Determination of Death Act defines “brain death” as the irreversible cessation of all functions of the entire brain, including the brainstem.
  3. 3. * * Pallis and Harley14 of the United Kingdom define the time of the first assessment for brain death as the point when the preconditions for the diagnosis of brain death have been met; unresponsive apneic coma, a cause of coma capable of producing brain death, and a determination that the damage is irremediable. * The Australian and New Zealand Intensive Care Society guidelines recommend that no fewer than 4 hours of documented coma should precede the first examination for brain death.
  4. 4. * The time of the first assessment for brain death is the point when the preconditions for the diagnosis of brain death have been met, with the following exceptions: * In cases of acute hypoxic-ischemic brain injury, clinical evaluation for NDD should be delayed for 24 hours after the cardiorespiratory arrest or when an ancillary test could be performed. * In cases of extreme metabolic insult, enough time should have passed for the clinician to think that the insult is permanent and there should be evidence of diffuse cerebral insult on imaging (magnetic resonance imaging [MRI]). If irreversibility remains an issue, an ancillary test should be performed in addition to the clinical examination.
  5. 5. * * Based on this evidence, the AAN guidelines state that a single examination suffices to establish the diagnosis but that US state statutes require 2 examinations, especially in the context of organ donation. * The Canadian guidelines state that for the purposes of a postmortem transplant, the fact of death shall be determined by at least 2 physicians. The examinations may be performed concurrently. However, if the determinations are performed at different times, a full clinical examination, including apnea testing, must be performed at each determination. No fixed interval of time is recommended for the second determination except when age-related criteria apply.
  6. 6. *Estabilidad cardiocirculatoria *Oxigenación y ventilación adecuada *Ausencia de hipotermia grave. *
  7. 7. *Alteraciones metabólicas *Intoxicaciones *Depresores del SNC. *Muerte tronco-encefálica aislada: Loss of ascending reticular activating system function would lead to the loss of consciousness the hypothalamus and interruption of the corticothalamic tract in his diagrams as an extended brainstem. *
  8. 8. *COMA ARREACTIVO *AUSENCIA DE REFLEJOS TRONCO-ENCEFALICOS. *AUSENCIA DE AUTONOMIA RESPIRATORIA: Test de atropina, test de apnea. *ACTIVIDAD MOTRIZ ESPINAL *
  9. 9. *ELECTROENCEFALOGRAMA *POTENCIALES EVOCADOS. *DOPPLER TRANSCRANEAL *GAMAGRAFIA CEREBRAL *ARTERIOGRAFIA CEREBRAL *
  10. 10. * RECOMMENDATIONS * The criteria for the determination of brain death given in the 1995 AAN practice parameter have not been invalidated by published reports of neurologic recovery in patients who fulfill these criteria. * 2. There is insufficient evidence to determine the minimally acceptable observation period To ensure that neurologic functions have ceased irreversibly. * 3. Complex-spontaneous motor movements and false-positive triggering of the ventilator may occur in patients who are brain dead. * 4. There is insufficient evidence to determine the comparative safety of techniques used for apnea testing . * 5. There is insufficient evidence to determine if newer ancillary tests accurately confirm the cessation of function of the entire brain. *
  11. 11. * Capítulo VI * De la Voluntad de Donación * Artículo 10.- Voluntad Presunta.- Es la presunción legal que establece que todos los ecuatorianos y extranjeros residentes legalmente en el país, mayores de dieciocho años, al fallecer se convertirán en donantes a menos que en vida hubiesen manifestado su voluntad en contrario, de acuerdo a lo establecido en el artículo 29 de la ley. *

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