Brain Death: Assessment, Controversy, and Confounding Factors

Author(s): Richard B. Arbour, RN, MSN, CCRN, CNRN, CCNS

Contact Hours 1.00

CERP A 1.00

Expires Dec 01, 2017

Topics: Neurology, Palliative/End-of-life Care

Population: Adult

Role: Staff

Member: Free
NonMember: $10.00

Added to Collection

Activity Summary

When brain injury is refractory to aggressive management and is considered nonsurvivable, with loss of consciousness and brain stem reflexes, a brain death protocol may be initiated to determine death according to neurological criteria. Clinical evaluation typically entails 2 consecutive formal neurological examinations to document total loss of consciousness and absence of brain stem reflexes and then apnea testing to evaluate carbon dioxide unresponsiveness within the brain stem. Confounding factors such as use of therapeutic hypothermia, high-dose metabolic suppression, and movements associated with complex spinal reflexes, fasciculations, or cardiogenic ventilator autotriggering may delay initiation or completion of brain death protocols. Neuro -diagnostic studies such as 4-vessel cerebral angiography can rapidly document absence of blood flow to the brain and decrease intervals between onset of terminal brain stem herniation and formal declaration of death by neurological criteria. Intracranial pathophysiology leading to brain death must be considered along with clinical assessment, patterns of vital signs, and relevant diagnostic studies.


  • Describe the pathophysiology of brain injury
  • Identify criteria for determining brain death
  • Discuss nursing care of patients with brain injury

Continuing Education Disclosure Statement

Successful Completion

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