Taking the pulse of brain death: A meta-analysis of the natural history of brain death with somatic support
The conceptualization of brain death (BD) was pivotal in the shaping of judicial and medical practices. Nonetheless, media reports of alleged recovery from BD reinforced the criticism that this construct is a self-fulfilling prophecy (by treatment withdrawal or organ donation). We meta-analyzed the...
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| Veröffentlicht in: | European journal of neurology 2024-05, Vol.31 (5), p.e16243 |
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| creator | Gambardella, Ivancarmine Nappi, Francesco Worku, Berhane Tranbaugh, Robert F Ibrahim, Aminat M Balaram, Sandhya K Bernat, James L |
| description | The conceptualization of brain death (BD) was pivotal in the shaping of judicial and medical practices. Nonetheless, media reports of alleged recovery from BD reinforced the criticism that this construct is a self-fulfilling prophecy (by treatment withdrawal or organ donation). We meta-analyzed the natural history of BD when somatic support (SS) is maintained.
Publications on BD were eligible if the following were reported: aggregated data on its natural history with SS; and patient-level data that allowed censoring at the time of treatment withdrawal or organ donation. Endpoints were as follows: rate of somatic expiration after BD with SS; BD misdiagnosis, including "functionally brain-dead" patients (FBD; i.e. after the pronouncement of brain-death, ≥1 findings were incongruent with guidelines for its diagnosis, albeit the lethal prognosis was not altered); and length and predictors of somatic survival.
Forty-seven articles were selected (1610 patients, years: 1969-2021). In BD patients with SS, median age was 32.9 years (range = newborn-85 years). Somatic expiration followed BD in 99.9% (95% confidence interval = 89.8-100). Mean somatic survival was 8.0 days (range = 1.6 h-19.5 years). Only age at BD diagnosis was an independent predictor of somatic survival length (coefficient = -11.8, SE = 4, p |
| doi_str_mv | 10.1111/ene.16243 |
| format | Article |
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Publications on BD were eligible if the following were reported: aggregated data on its natural history with SS; and patient-level data that allowed censoring at the time of treatment withdrawal or organ donation. Endpoints were as follows: rate of somatic expiration after BD with SS; BD misdiagnosis, including "functionally brain-dead" patients (FBD; i.e. after the pronouncement of brain-death, ≥1 findings were incongruent with guidelines for its diagnosis, albeit the lethal prognosis was not altered); and length and predictors of somatic survival.
Forty-seven articles were selected (1610 patients, years: 1969-2021). In BD patients with SS, median age was 32.9 years (range = newborn-85 years). Somatic expiration followed BD in 99.9% (95% confidence interval = 89.8-100). Mean somatic survival was 8.0 days (range = 1.6 h-19.5 years). Only age at BD diagnosis was an independent predictor of somatic survival length (coefficient = -11.8, SE = 4, p < 0.01). Nine BD misdiagnoses were detected; eight were FBD, and one newborn fully recovered. No patient ever recovered from chronic BD (≥1 week somatic survival).
BD diagnosis is reliable. Diagnostic criteria should be fine-tuned to avoid the small incidence of misdiagnosis, which nonetheless does not alter the prognosis of FBD patients. Age at BD diagnosis is inversely proportional to somatic survival.</description><identifier>ISSN: 1351-5101</identifier><identifier>ISSN: 1468-1331</identifier><identifier>EISSN: 1468-1331</identifier><identifier>DOI: 10.1111/ene.16243</identifier><identifier>PMID: 38375732</identifier><language>eng</language><publisher>England: John Wiley & Sons, Inc</publisher><subject>Age ; Aged, 80 and over ; Blood & organ donations ; Brain ; Brain death ; Brain Death - diagnosis ; Cause of Death ; Death ; Diagnosis ; Expiration ; Humans ; Incidence ; Infant, Newborn ; Medical prognosis ; Mortality ; Natural history ; Patients ; Prognosis ; Survival ; Tissue and Organ Procurement ; Tissue Donors</subject><ispartof>European journal of neurology, 2024-05, Vol.31 (5), p.e16243</ispartof><rights>2024 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.</rights><rights>2024. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the "License"). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c308t-873a04d13d5d2925385cefe625980e891eed2611c327e27edf578e73a9fa20533</cites><orcidid>0000-0002-5258-834X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38375732$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gambardella, Ivancarmine</creatorcontrib><creatorcontrib>Nappi, Francesco</creatorcontrib><creatorcontrib>Worku, Berhane</creatorcontrib><creatorcontrib>Tranbaugh, Robert F</creatorcontrib><creatorcontrib>Ibrahim, Aminat M</creatorcontrib><creatorcontrib>Balaram, Sandhya K</creatorcontrib><creatorcontrib>Bernat, James L</creatorcontrib><title>Taking the pulse of brain death: A meta-analysis of the natural history of brain death with somatic support</title><title>European journal of neurology</title><addtitle>Eur J Neurol</addtitle><description>The conceptualization of brain death (BD) was pivotal in the shaping of judicial and medical practices. Nonetheless, media reports of alleged recovery from BD reinforced the criticism that this construct is a self-fulfilling prophecy (by treatment withdrawal or organ donation). We meta-analyzed the natural history of BD when somatic support (SS) is maintained.
Publications on BD were eligible if the following were reported: aggregated data on its natural history with SS; and patient-level data that allowed censoring at the time of treatment withdrawal or organ donation. Endpoints were as follows: rate of somatic expiration after BD with SS; BD misdiagnosis, including "functionally brain-dead" patients (FBD; i.e. after the pronouncement of brain-death, ≥1 findings were incongruent with guidelines for its diagnosis, albeit the lethal prognosis was not altered); and length and predictors of somatic survival.
Forty-seven articles were selected (1610 patients, years: 1969-2021). In BD patients with SS, median age was 32.9 years (range = newborn-85 years). Somatic expiration followed BD in 99.9% (95% confidence interval = 89.8-100). Mean somatic survival was 8.0 days (range = 1.6 h-19.5 years). Only age at BD diagnosis was an independent predictor of somatic survival length (coefficient = -11.8, SE = 4, p < 0.01). Nine BD misdiagnoses were detected; eight were FBD, and one newborn fully recovered. No patient ever recovered from chronic BD (≥1 week somatic survival).
BD diagnosis is reliable. Diagnostic criteria should be fine-tuned to avoid the small incidence of misdiagnosis, which nonetheless does not alter the prognosis of FBD patients. Age at BD diagnosis is inversely proportional to somatic survival.</description><subject>Age</subject><subject>Aged, 80 and over</subject><subject>Blood & organ donations</subject><subject>Brain</subject><subject>Brain death</subject><subject>Brain Death - diagnosis</subject><subject>Cause of Death</subject><subject>Death</subject><subject>Diagnosis</subject><subject>Expiration</subject><subject>Humans</subject><subject>Incidence</subject><subject>Infant, Newborn</subject><subject>Medical prognosis</subject><subject>Mortality</subject><subject>Natural history</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Survival</subject><subject>Tissue and Organ Procurement</subject><subject>Tissue Donors</subject><issn>1351-5101</issn><issn>1468-1331</issn><issn>1468-1331</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNpdkU1PwzAMhiMEYmNw4A-gSFzg0JHETZtymya-pElcxrnKWpd16xdJKrR_T8oGh1mRHSmPXyt-CbnmbMp9PGCDUx6JEE7ImIeRCjgAP_V3kDyQnPERubB2wxgTsWDnZAQKYhmDGJPtUm_L5pO6NdKuryzStqAro8uG5qjd-pHOaI1OB7rR1c6Wdngf4Ea73uiKrkvrWrM7aqPfpU-2rbUrM2r7rmuNuyRnhfYjrg51Qj6en5bz12Dx_vI2ny2CDJhygYpBszDnkMtcJEKCkhkWGAmZKIYq4Yi5iDjPQMToT17IWKFvSgotmASYkLu9bmfarx6tS-vSZlhVusG2t6kXVUqKJB7Q2yN00_bGf9WmwCBkid_XQN3vqcy01hos0s6UtTa7lLN0cCD1DqS_Dnj25qDYr2rM_8m_lcMPzqV_6Q</recordid><startdate>202405</startdate><enddate>202405</enddate><creator>Gambardella, Ivancarmine</creator><creator>Nappi, Francesco</creator><creator>Worku, Berhane</creator><creator>Tranbaugh, Robert F</creator><creator>Ibrahim, Aminat M</creator><creator>Balaram, Sandhya K</creator><creator>Bernat, James L</creator><general>John Wiley & Sons, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7U7</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5258-834X</orcidid></search><sort><creationdate>202405</creationdate><title>Taking the pulse of brain death: A meta-analysis of the natural history of brain death with somatic support</title><author>Gambardella, Ivancarmine ; 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Nonetheless, media reports of alleged recovery from BD reinforced the criticism that this construct is a self-fulfilling prophecy (by treatment withdrawal or organ donation). We meta-analyzed the natural history of BD when somatic support (SS) is maintained.
Publications on BD were eligible if the following were reported: aggregated data on its natural history with SS; and patient-level data that allowed censoring at the time of treatment withdrawal or organ donation. Endpoints were as follows: rate of somatic expiration after BD with SS; BD misdiagnosis, including "functionally brain-dead" patients (FBD; i.e. after the pronouncement of brain-death, ≥1 findings were incongruent with guidelines for its diagnosis, albeit the lethal prognosis was not altered); and length and predictors of somatic survival.
Forty-seven articles were selected (1610 patients, years: 1969-2021). In BD patients with SS, median age was 32.9 years (range = newborn-85 years). Somatic expiration followed BD in 99.9% (95% confidence interval = 89.8-100). Mean somatic survival was 8.0 days (range = 1.6 h-19.5 years). Only age at BD diagnosis was an independent predictor of somatic survival length (coefficient = -11.8, SE = 4, p < 0.01). Nine BD misdiagnoses were detected; eight were FBD, and one newborn fully recovered. No patient ever recovered from chronic BD (≥1 week somatic survival).
BD diagnosis is reliable. Diagnostic criteria should be fine-tuned to avoid the small incidence of misdiagnosis, which nonetheless does not alter the prognosis of FBD patients. Age at BD diagnosis is inversely proportional to somatic survival.</abstract><cop>England</cop><pub>John Wiley & Sons, Inc</pub><pmid>38375732</pmid><doi>10.1111/ene.16243</doi><orcidid>https://orcid.org/0000-0002-5258-834X</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Age Aged, 80 and over Blood & organ donations Brain Brain death Brain Death - diagnosis Cause of Death Death Diagnosis Expiration Humans Incidence Infant, Newborn Medical prognosis Mortality Natural history Patients Prognosis Survival Tissue and Organ Procurement Tissue Donors |
| title | Taking the pulse of brain death: A meta-analysis of the natural history of brain death with somatic support |
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