Case of the Month #32 Brain Stem Death

Published 03/10/2022

What are the “red flags” patient groups?

Diagnostic caution is advised in the following ‘Red Flag’ patient groups. (Based on the literature and unpublished case reports.) For advice in difficult circumstances contact the local or regional Clinical Lead for Organ Donation or the regional neuro-intensive care unit [6].

  1. Testing < 6 hours of the loss of the last brain-stem reflex
  2. Testing <24 hours of the loss of the last brain-stem reflex, where aetiology primarily anoxic damage
  3. Hypothermia (24 hour observation period following re-warming to normothermia recommended)
  4. Patients with any neuromuscular disorders
  5. Steroids given for space occupying lesions such as abscesses
  6. Prolonged fentanyl infusions
  7. Aetiology primarily located to the brain-stem or posterior fossa
  8. Therapeutic decompressive craniectomy