Otherwise known as “brain death,” death by neurological criteria was developed as a response to the development of advanced life support technology that was able to preserve vital functions despite devastating injury or illness. But, it is a confusing term and not just to families, but also to medical professionals who don’t deal with it on a regular basis. It is important to understand that “brain death” is no different than “cardiac death.” When discussing this with families, I like to explain, “if you were to have a massive heart attack and die, you don’t technically die because your heart stopped. You die because the brain dies. The brain dies because of lack of blood flow due to the fact that the heart has stopped.”
This may seem semantic, but it is an important note. Death is death, regardless of the proximate cause. Prior to the advent of advanced life support, people died of heart and lung failure before their brains failed. However, in the case of brain death, often brain injury is the proximate cause of death rather than secondary to the failure of other organ systems. There is often misunderstanding that “brain death” is not “real death” which can lead to the confusion among families that the medical team is “giving up.”
Recently, Dennis Kim shared an excellent article from the NEJM on Twitter regarding brain death determination that resulted in a good thread where providers who deal with this regularly share tips for having this conversation and performing this exam. Almost simultaneously, @pulmcritdoc shared this excellent summary on Instagram:
critical care notes 