Variability in Brain Death Determination in Europe: Looking for a Solution
Variability in Brain Death Determination in Europe: Looking for a Solution
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DOI：
10.1007/s12028-014-9983-x
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发表时间：
2014-12-01
影响因子：
3.5
通讯作者：
Smith, Martin
中科院分区：
文献类型：
--
作者：
Citerio, Giuseppe;Crippa, Ilaria Alice;Smith, Martin
判定脑死亡（BD）的标准在不同国家之间存在差异。我们报告了一项旨在比较不同欧洲国家判定脑死亡程序的调查结果。我们设计了一份基于网络的调查问卷，并发送给33个欧洲国家的代表。对回复进行了审查，如果需要澄清，会与个别回复者联系。调查问卷发送给33个国家，收到了其中28个国家（85%）的回复。每个国家都有用于定义脑死亡的法律（93%）或国家指南（89%）。在50%的国家中，临床检查足以判定脑死亡；昏迷、呼吸暂停、角膜反射和咳嗽反射消失在所有国家都是必备标准。所有国家都要求确认呼吸暂停，但有4个国家（14%）未对此进行定义。在对呼吸暂停测试有正式定义的24个国家（86%）中，大多数国家将目标二氧化碳分压（pCO₂）水平（23/24，96%）作为预先设定的终点。临床检查的次数（中位数为2次，范围为1 - 3次）以及检查之间的最短观察时间（3小时，范围为0 - 12小时）在各国之间差异很大。50%的国家需要额外（确认性）检查。低温（4%）、缺氧性损伤（7%）、无法完成临床检查（61%）、药物中毒水平（57%）以及呼吸暂停测试结果不确定（54%）是进行确认性检查最常见的指征。在18%的国家中，脑血流（CBF）检查是强制性的，但在82%的国家中是可选的或仅在特定病例中才需要。常规血管造影是判定脑血流缺失的首选方法（50%），其次是经颅多普勒超声检查（43%）、计算机断层扫描（CT）血管造影（39%）、CT灌注以及磁共振成像（MRI）血管造影（11%）。脑电图总是（21%）或可选地（14%）被记录。尽管所有欧洲国家都有立法或专业指南来规范脑死亡诊断过程，但各国之间仍然存在差异。当前实践中的差异使得就脑死亡的定义达成国际共识变得势在必行。
Criteria for determining brain death (BD) vary between countries. We report the results of an investigation designed to compare procedures to determine BD in different European countries.We developed a web-based questionnaire that was sent to representatives of 33 European countries. Responses were reviewed, and individual respondents were contacted if clarification was required.Responses were received from 28 (85 %) of the 33 countries to which the questionnaire was sent. Each country has either a law (93 %) or national guidance (89 %) for defining BD. Clinical examination is sufficient to determine BD in 50 % of countries; coma, apnea, absence of corneal, and cough reflexes are mandatory criteria in all. Confirmation of apnea is required in all countries but not defined in 4 (14 %). In the 24 (86 %) of countries with a formal definition of the apnea test, a target pCO(2) level (23/24, 96 %) is the pre-specified end point in most. The (median, range) number of clinical examinations (2, 1-3) and minimum observation time between tests (3 h, 0-12 h) vary greatly between countries. Additional (confirmatory) tests are required in 50 % of countries. Hypothermia (4 %), anoxic injury (7 %), inability to complete clinical examination (61 %), toxic drug levels (57 %), and inconclusive apnea test (54 %) are among the most common indications for confirmatory tests. Cerebral blood flow (CBF) investigation is mandatory in 18 % of countries, but optional or indicated only in selected cases in 82 %. Conventional angiography is the preferred method of determining absent CBF (50 %), followed by transcranial Doppler sonography (43 %), computerized tomography (CT) angiography (39 %), CT perfusion, and magnetic resonance imaging (MRI) angiography (11 %). Electroencephalography is always (21 %) or optionally (14 %) recorded.Although legislation or professional guidance is available to standardize nationally the BD diagnosis process in all European countries, there are still disparities between countries. The current variation in practice makes an international consensus for the definition of BD imperative.