The aim of this study is to assess and survey the quality of the process required to diagnose brain death in adult patients. This study of adult patients diagnosed brain dead or suspected of having brain death on the ICUs at the University Hospital Basel will be purely observational.
Study Type
OBSERVATIONAL
Enrollment
100
Assessment of process required to diagnose brain death in adult patients (demographics, clinical, laboratory, imaging, and treatment data). No questionnaires or study visits will be used.
Clinic for Intensive Care Medicine, University Hospital Basel
Basel, Switzerland
adherence to the local brain death protocol ( = measurement tool) for the process of brain death diagnosis
the local brain death protocol ( = measurement tool) requires 1.) exclusion of the following conditions: * shock (mean arterial blood pressure \> 60 mmHg, lactate \< 4 mmol/l) * hypothermia (temperature \> 35°C) * severe acidosis (pH \> 7.3) * hyperosmolarity (osmolarity \< 320 mmol/l) * severe electrolyte disorders (sodium \> 125 mmol/l, phosphate \> 0.3 mmol/l) * hypoglycemia (glucose \> 4 mmol/l) * hyperammonemia (ammonia \< 60 mumol/l) * uremia (urea \< 25 mmol/l) * prolonged effects of medication (muscle relaxants, sedatives, recreational drugs) * severe hypothyreosis 2.) clinical examination confirming: * fixed pupils (dilated or mid-dilated bilaterally) * absent vestibulo-ocular reflex * absent corneal reflex bilaterally * no reaction to painful stimulus bilaterally * absence of cough and gag reflex * absence of spontaneous breathing (apnea test)
Time frame: single time point assessment at baseline (after suspected brain death)
number of physicians involved
number of physicians involved in the diagnostic procedures
Time frame: single time point assessment at baseline (after suspected brain death)
frequency of ancillary tests performed
frequency of ancillary tests (i.e. transcranial doppler ultrasound, computed tomography, magnetic resonance tomography, digital substraction angiography, electroencephalogram, somatosensory evoked potentials) performed
Time frame: single time point assessment at baseline (after suspected brain death)
number of work-ups excluding suspected brain death
number of work-ups excluding suspected brain death
Time frame: single time point assessment at baseline (after suspected brain death)
number of diagnostic work-ups with insufficient performance and/or documentation
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number of diagnostic work-ups with insufficient performance and/or documentation
Time frame: single time point assessment at baseline (after suspected brain death)
years of clinical experience of physicians involved
years of clinical experience of physicians involved in the diagnostic procedures
Time frame: single time point assessment at baseline (after suspected brain death)