Brain death determination in Australia and New Zealand: a survey of intensive care units.

BACKGROUND: The Australian and New Zealand Intensive Care Society (ANZICS) guidelines for the determination of brain death involve clinical testing and/or the use of brain blood flow analysis techniques. Recently, there has been professional and lay discussion regarding the role of brain blood flow analysis in the determination of brain death.

OBJECTIVE: To determine the current practices in Australian and New Zealand intensive care units for the determination of brain death.

METHODS: All adult ICUs in Australia and New Zealand accredited for training in intensive care by the College of Intensive Care Medicine of Australia and New Zealand were surveyed to determine the unit size, whether certification of brain death occurs in that unit, and the method routinely used to determine brain death if there were no contraindications to clinical testing.

RESULTS: There were 47 responses (53% response rate). Of the surveyed units, 89% of units used two sets of clinical tests for brain death determination; 9% used one set of clinical testing and one imaging technique; and 2% of units used one imaging technique only. When an imaging technique was used, four units used radionuclide imaging, one unit used magnetic resonance imaging and one unit used computed tomography angiography.

CONCLUSIONS: Two sets of clinical testing is the most common method for determining brain death in Australian and New Zealand ICUs. A minority of units used some form of brain blood flow imaging. Based on these findings, all brain death certification is in accordance with ANZICS guidelines.