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March 7, 1977, Vol 237, No. 10 >
ARTICLE | March 7, 1977

An Appraisal of the Criteria of Cerebral Death: Title and subTitle BreakA Summary Statement FREE

[+] Author Affiliations

For complete list of all participants see p 986.

The views expressed are those of the authors and do not necessarily reflect the opinions of the National Institute of Neurological and Communicative Disorders and Stroke.

Reprint requests to the Division of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, NM 87131 (Dr Walker).


JAMA. 1977;237(10):982-986. doi:10.1001/jama.1977.03270370054022
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Based on the findings in a collaborative study of 503 comatose and apneic patients, the establishment of cerebral death requires (1) that all appropriate examinations and therapeutic procedures have been performed, (2) that cerebral unresponsivity, apnea, dilated pupils, absent cephalic reflexes, and electrocerebral silence be present for 30 minutes at least six hours after the ictus, and (3) that if one of these standards is met imprecisely or cannot be tested, a confirmatory test be made to demonstrate the absence of cerebral blood flow. This would allow the diagnosis of a dead brain to be made in patients with small amounts of sedative drugs in the blood, in patients undergoing therapeutic procedures that make examination of one or more of the cranial nerves impossible, and in patients otherwise meeting the criteria whose pupils are small.

(JAMA 237:982-986, 1977)

REFERENCES

1 +
 A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death . JAMA 205:337-340, 1968;.
2 +
Ingvar DH, Widen L: Brain death:  Summary of a symposium . Lakartidningen 69:3804-3814, 1972;.
3 +
Mohandas A, Chou SN:  Brain death: A clinical and pathological study . J Neurosurg 35:211-218, 1971;.
4 +
Plum F, Posner JB: The diagnosis of Stupor and Coma , ed 2. Philadelphia, FA Davis Co, 1972;, ix + 286 pp.
5 +
Prior, PF: The EEG in acute cerebral anoxia. Assessment of cerebral function and prognosis in patients resuscitated after cardiorespiratory arrest . Amsterdam, Exerpta Medica. 1973;, 811 + 314 pp.
6 +
Ueki K, Takeuchi K, Katsurada K:  Clinical study of brain death . Read before the Fifth In ternational Congress of Neurological Surgery, Tokyo, Japan, October 1973.
7 +
Bennett DR, Hughes JR, Korein J, et al: Atlas of Electroencephalography in Coma and Cerebral Death . New York, Raven Press, 1976;, pp 254.
8 +
Walker AE, Diamond EL, Moseley JI:  The neuropathological findings in irreversible coma: A critique of the "respirator brain ." J Neuropathol Exp Neurol 34:295-323, 1975;.
9 +
Walker AE, Molinari GF:  The clinical applicability of sedative drug surveys in coma . Postgrad Med , to be published.
10 +
 Cerebral death and the electroencephalogram. Report of the Ad Hoc Committee of the American Electroencephalographic Society on EEG Criteria for Determination of Cerebral Death . JAMA 209:1505-1510, 1969;.
11 +
Fischgold H, Mathis P:  Onubliations, comas, et stupeurs . Electroencephalogr Clin Neurophysiol 11( (suppl) ):16, 1959;.
12 +
Bricolo A, Benati A, Mazza C, et al:  Prolonged isoelectric EEG in a case of post-traumatic coma . Electroencephalogr Clin Neurophysiol 31:174, 1971;.
13 +
Tentler RL, Sadove M, Becka DR, et al:  Electroencephalographic evidence of cortical 'death' followed by full recovery: Protective action of hypothermia . JAMA 164:1667-1670, 1957;.
14 +
Silverman D, Masland R, Saunders MG, et al:  EEG and cerebral death: The neurologist's view . Electroencephalogr Clin Neurophysiol 27:549, 1969;.
15 +
Korein J, Braunstein P, Kricheff I, et al:  Radioisotopic bolus technique as a test to detect circulatory deficit associated with cerebral death . Circulation 51:924-937, 1975;.
16 +
Uematsu S, Walker AE:  Pulsatile cerebral midline echo and brain death . Johns Hopkins Med J 135:383-390, 1974;.

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1 +
 A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death . JAMA 205:337-340, 1968;.
2 +
Ingvar DH, Widen L: Brain death:  Summary of a symposium . Lakartidningen 69:3804-3814, 1972;.
3 +
Mohandas A, Chou SN:  Brain death: A clinical and pathological study . J Neurosurg 35:211-218, 1971;.
4 +
Plum F, Posner JB: The diagnosis of Stupor and Coma , ed 2. Philadelphia, FA Davis Co, 1972;, ix + 286 pp.
5 +
Prior, PF: The EEG in acute cerebral anoxia. Assessment of cerebral function and prognosis in patients resuscitated after cardiorespiratory arrest . Amsterdam, Exerpta Medica. 1973;, 811 + 314 pp.
6 +
Ueki K, Takeuchi K, Katsurada K:  Clinical study of brain death . Read before the Fifth In ternational Congress of Neurological Surgery, Tokyo, Japan, October 1973.
7 +
Bennett DR, Hughes JR, Korein J, et al: Atlas of Electroencephalography in Coma and Cerebral Death . New York, Raven Press, 1976;, pp 254.
8 +
Walker AE, Diamond EL, Moseley JI:  The neuropathological findings in irreversible coma: A critique of the "respirator brain ." J Neuropathol Exp Neurol 34:295-323, 1975;.
9 +
Walker AE, Molinari GF:  The clinical applicability of sedative drug surveys in coma . Postgrad Med , to be published.
10 +
 Cerebral death and the electroencephalogram. Report of the Ad Hoc Committee of the American Electroencephalographic Society on EEG Criteria for Determination of Cerebral Death . JAMA 209:1505-1510, 1969;.
11 +
Fischgold H, Mathis P:  Onubliations, comas, et stupeurs . Electroencephalogr Clin Neurophysiol 11( (suppl) ):16, 1959;.
12 +
Bricolo A, Benati A, Mazza C, et al:  Prolonged isoelectric EEG in a case of post-traumatic coma . Electroencephalogr Clin Neurophysiol 31:174, 1971;.
13 +
Tentler RL, Sadove M, Becka DR, et al:  Electroencephalographic evidence of cortical 'death' followed by full recovery: Protective action of hypothermia . JAMA 164:1667-1670, 1957;.
14 +
Silverman D, Masland R, Saunders MG, et al:  EEG and cerebral death: The neurologist's view . Electroencephalogr Clin Neurophysiol 27:549, 1969;.
15 +
Korein J, Braunstein P, Kricheff I, et al:  Radioisotopic bolus technique as a test to detect circulatory deficit associated with cerebral death . Circulation 51:924-937, 1975;.
16 +
Uematsu S, Walker AE:  Pulsatile cerebral midline echo and brain death . Johns Hopkins Med J 135:383-390, 1974;.

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