🧠 Brain Death / Death by Neurologic Criteria (DNC) Determination
Work through the adult brain-death / death-by-neurologic-criteria determination: prerequisites, brainstem-reflex examination and the apnea test. Instant, browser-side.
Brain Death / Death by Neurologic Criteria (DNC) Determination
Prerequisites
Clinical examination
Apnea test
When to use
Structured clinical determination of brain death (BD/DNC) per the AAN/AAP/CNS/SCCM 2023 consensus.
How it works
All three must hold: prerequisites (irreversible cause, confounders excluded, core temp ≥ 36℃, SBP ≥ 100 / adequate MAP, no hypoxia) + all brainstem reflexes absent in a comatose patient with no induced movement + a positive apnea test (PaCO₂ ≥ 60 and ↑ ≥ 20 over baseline). Ancillary testing only when the exam/apnea test cannot be completed.
Key points
- Confounders (drugs, severe metabolic/electrolyte derangement, neuromuscular blockade, hypothermia) must be corrected/excluded before determination.
- The apnea test is positive only with no respiratory effort AND PaCO₂ ≥ 60 AND a ≥ 20 mmHg rise over baseline.
- EEG assesses the cerebral hemispheres, not the brainstem; cerebral-blood-flow studies (CTA/DSA/TCD/nuclear) are the ancillary options.
- Spinally mediated movements do not exclude brain death; follow hospital/regional policy on examiner qualifications and documentation.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.