Skip to Main Content

For further information, see CMDT Part 26-17: Stupor & Coma

KEY FEATURES

  • Complete and irreversible cessation of all brain function

  • Cause of coma must be established, be compatible with a known cause of brain death, and be irreversible

  • Reversible coma simulating brain death may be seen with

    • Hypothermia (temperature < 32 °C)

    • Overdosage with central nervous system depressant drugs

  • Hypothermia and drug overdose must be excluded by warming the patient and allowing enough time for all sedating medications to be metabolized (ie, at least five half-lives) or by measuring serum drug levels

  • Severe blood pressure, electrolyte, acid-base, and endocrine derangements cannot be present

CLINICAL FINDINGS

  • Coma (irreversible)

  • No response to external stimulation

  • No brainstem reflexes

  • No spontaneous respirations and no respirations during apnea test

DIAGNOSIS

  • The apnea test (absence of spontaneous respiratory activity at a PaCO2 of at least 60 mm Hg or after a rise of 20 mm Hg from baseline) serves to determine that the patient is incapable of spontaneous respiratory activity

  • If an isoelectric electroencephalogram is recorded (according to the recommendations of the American Electroencephalographic Society), brain death should not be assumed unless brainstem auditory and somatosensory evoked potentials are also performed to assess brainstem function

  • The demonstration of an absent cerebral circulation by intravenous radioisotope cerebral angiography or four-vessel contrast cerebral angiography is confirmatory

TREATMENT

  • Palliative care, end-of-life measures

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

  • Create a Free Profile