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. 2023 Dec 12;101(24):1112-1132.
doi: 10.1212/WNL.0000000000207740. Epub 2023 Oct 11.

Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Guideline

David M Greer  1 , Matthew P Kirschen  1 , Ariane Lewis  1 , Gary S Gronseth  1 , Alexander Rae-Grant  1 , Stephen Ashwal  1 , Maya A Babu  1 , David F Bauer  1 , Lori Billinghurst  1 , Amanda Corey  1 , Sonia Partap  1 , Michael A Rubin  1 , Lori Shutter  1 , Courtney Takahashi  1 , Robert C Tasker  1 , Panayiotis Nicolaou Varelas  1 , Eelco Wijdicks  1 , Amy Bennett  1 , Scott R Wessels  1 , John J Halperin  1
Affiliations

Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Guideline

David M Greer et al. Neurology. .

Erratum in

Abstract

Background and objectives: The purpose of this guideline is to update the 2010 American Academy of Neurology (AAN) brain death/death by neurologic criteria (BD/DNC) guideline for adults and the 2011 American Academy of Pediatrics, Child Neurology Society, and Society of Critical Care Medicine guideline for infants and children and to clarify the BD/DNC determination process by integrating guidance for adults and children into a single guideline. Updates in this guideline include guidance related to conducting the BD/DNC evaluation in the context of extracorporeal membrane oxygenation, targeted temperature management, and primary infratentorial injury.

Methods: A panel of experts from multiple medical societies developed BD/DNC recommendations. Because of the lack of high-quality evidence on the subject, a novel, evidence-informed formal consensus process was used. This process relied on the panel experts' review and detailed knowledge of the literature surrounding BD/DNC to guide the development of preliminary recommendations. Recommendations were formulated and voted on, using a modified Delphi process, according to the 2017 AAN Clinical Practice Guideline Process Manual.

Major recommendations: Eighty-five recommendations were developed on the following: (1) general principles for the BD/DNC evaluation, (2) qualifications to perform BD/DNC evaluations, (3) prerequisites for BD/DNC determination, (4) components of the BD/DNC neurologic examination, (5) apnea testing as part of the BD/DNC evaluation, (6) ancillary testing as part of the BD/DNC evaluation, and (7) special considerations for BD/DNC determination.

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Conflict of interest statement

The AAN's Conflict of Interest Policy is available at aan.com/AAN-Resources/Details/about-the-aan/organizational-policies/. All AAN guideline authors must meet the stipulations outlined in the policy to participate on a guideline development panel. This policy is further described in the 2017 AAN Clinical Practice Guideline Development Manual, available at aan.com/siteassets/home-page/policy-and-guidelines/guidelines/about-guidelines/17guidelineprocman_pg.pdf.

D.M. Greer has received travel funding from Boston University, serves as Editor-in-Chief for Seminars in Neurology, receives publishing royalties for 50 Studies Every Neurologist Should Know and Successful Leadership in Academic Medicine, has received honoraria from the American Academy of Neurology (AAN), has received research funding from Becton, Dickinson, and Company, and has served as expert witness in legal proceedings. M.P. Kirschen has received funding for travel from AAN/Child Neurology Society and has received research support from Masimo, Infrascan, and the Neurocritical Care Society. A. Lewis has received honoraria from AAN and Neurodiem, serves as Neurology® Deputy Editor of Disputes and Debates, and serves as Deputy Editor of Seminars in Neurology. G.S. Gronseth has received personal compensation in the range of $10,000 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology, has received personal compensation in the range of $0–$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Brain & Life, and has received personal compensation in the range of $0–$499 for serving as a member/evidence-based medicine consultant on the AAN Guidelines Subcommittee. A. Rae-Grant has received royalties for editing or coediting multiple textbooks with Springer Publishing and Wolters-Kluwer publisher and works part time for Ebsco Industries editing point-of-care evidence-based information for DynaMed, a subscription-based point-of-care tool for clinicians. S. Ashwal serves on the medical advisory board of the Tuberous Sclerosis Association and receives publishing royalties as coeditor of Pediatric Neurology: Principles and Practice. M.A. Babu has testified at a grand jury hearing relating to brain injury. D.F. Bauer has received research funding from the NIH and Park-Reeves collaborative. L. Billinghurst reports no disclosures relevant to the manuscript. A. Corey has performed blinded case review of MRI and CT scans for RadMD LLC, has received travel funding from Georgia Radiological Society, and is employed by the Department of Veterans Affairs. S. Partap has received honoraria from AAN and the American Academy of Pediatrics, has served on advisory boards for Bayer and GLG, and has received research support from the National Cancer Institute. M.A. Rubin has received travel funding from AAN and the Neurocritical Care Society, serves on the editorial board for Neurology Today, and has received honoraria from the University of Texas Tyler and Cooper Clinic. L. Shutter serves on a scientific advisory board for SENSE NeuroDiagnostics, serves on the ACCM Board of Regents, has received travel funding from SENSE NeuroDiagnostics, has received honoraria from the AAN, has received research support from the Chuck Noll Foundation, receives publishing royalties as coeditor of Pittsburgh Critical Care Medicine: Neurocritical Care, and has served as an expert witness and counsel in legal proceedings. C. Takahashi reports no disclosures relevant to the manuscript. R.C. Tasker has served as an NIH grant reviewer, serves as Senior Associate Editor for Archives of Disease in Childhood, serves as ad hoc reviewer for Intensive Care Medicine, serves as editor of the pediatric neurology section of Current Opinions in Pediatrics, serves as Editor-in-Chief of the Society of Critical Care Medicine journal Pediatric Critical Care Medicine, receives publishing royalties from Nelson's Textbook of Pediatrics, edition 21, Oxford Handbook of Paediatrics and Child Health, edition 2, Roger's Textbook of Pediatric Intensive Care, edition 5, UpToDate, 2 chapters: ICP treatment and ICP recognition, and has received research support from NIH and Boston Children's Hospital. P.N. Varelas serves on a scientific advisory board for Portola, has received honoraria from Portola, serves on a speakers' bureau for Portola, serves on an advisory board for UBC, serves on the editorial board of Neurocritical Care, has received royalties for the book Seizures in Critical Care, and has received research funding from Marinus and Bard. E. Wijdicks receives publishing royalties from Oxford Press for Brain Death. A. Bennett reports no disclosures relevant to the manuscript. S.R. Wessels reports no disclosures relevant to the manuscript. J.J. Halperin has received personal compensation in the range of $500–$4,999 for serving as an Expert Witness for Tri-Century Insurance Company, has received intellectual property interests from 3 publications relating to health care, and has received personal compensation in the range of $0–$499 for serving as a medical consultant with TelaDoc, and Dr. Halperin's institution has received research support from the NIH. Go to Neurology.org/N for full disclosures.

References

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