Confirmatory tests for brain death
ERRATA: EEG, not EKG!
Should be used when clinical criteria alone cannot be applied, such as:
sedation / muscle paralysis
can’t examine cranial nerves
carbon dioxide retainer (ie, COPD) → can’t do apnea test
shorten observation period
Confirmatory tests
Cerebral angiography, the gold standard, invasive: can absent blood flow at or beyond the carotid bifurcation or circle of Willis.
Transcranial Doppler, bedside, safe and noninvasive: expertise required, examination of both anterior and posterior circulation required.
Magnetic resonance angiography, can show absence of arterial blood flow, but clinical monitoring might be difficult
Computed tomographic angiography, invasive, requires iodine contrast, lower sensitivity test
Radionuclide brain imaging, with tracer 99mTc-labeled hexamethylpropyleneamine oxime + single-photon emission CT brain scintigraphy → tracer penetrates brain proportionally to blood flow → no redistribution (hollow skull phenomenon)
Electroencephalography (EEG), useful in very young. A flat EEG, which is called electrocerebral silence, will be present. Need nonartifactual electrical potentials over 2 μV within a 30-minute recording period (requires 2x, 24-hour apart)
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