🧠 Brain Death / Death by Neurologic Criteria (DNC) Determination
UseStructured clinical determination of brain death (BD/DNC) per the AAN/AAP/CNS/SCCM 2023 consensus.
SourceGreer DM, et al. Determination of Brain Death/Death by Neurologic Criteria: 2023 Consensus Guidelin…
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
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Methodology · worked example, guidelines & full notes
Confounders (drugs, severe metabolic/electrolyte derangement, neuromuscular blockade, hypothermia) must be corrected/excluded before determination.
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
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Prerequisites | All met (known irreversible cause + confounders excluded [drug intoxication / severe metabolic-electrolyte-acid-base / neuromuscular blockade] + core temp ≥ 36℃ + SBP ≥ 100 or adequate MAP + no hypoxia) |
|---|---|
| Clinical examination | Coma with no induced movement + pupillary/corneal/oculocephalic/oculovestibular/pharyngeal/cough reflexes all absent |
| Apnea test | Negative (respiratory effort appears) |
→Brain-death determinationDoes not meet (apnea test negative)
- Conclusion：Any spontaneous respiratory effort means brain death is not met.
- Examination items (all must be absent)：Unresponsiveness/no induced movement, pupillary light reflex, corneal reflex, oculocephalic reflex (OCR), oculovestibular reflex (OVR), pharyngeal (gag) reflex, cough reflex (add sucking/rooting reflexes if < 6 months old)
- Positive apnea test：No spontaneous respiratory effort AND PaCO₂ ≥ 60 mmHg AND ↑ ≥ 20 mmHg over baseline (adults ≥ 1 time after the final examination)
| Prerequisites | All met (known irreversible cause + confounders excluded [drug intoxication / severe metabolic-electrolyte-acid-base / neuromuscular blockade] + core temp ≥ 36℃ + SBP ≥ 100 or adequate MAP + no hypoxia) |
|---|---|
| Clinical examination | Coma with no induced movement + pupillary/corneal/oculocephalic/oculovestibular/pharyngeal/cough reflexes all absent |
| Apnea test | Positive: no spontaneous breathing AND PaCO₂ ≥ 60 AND ↑ ≥ 20 mmHg over baseline |
→Brain-death determinationMeets clinical brain-death criteria
- Conclusion：Prerequisites + all brainstem reflexes absent + positive apnea test are all satisfied. Time of death is recorded as the moment of the final apnea-test blood-gas report (PaCO₂/pH meeting criteria). Spinally mediated movements do not exclude brain death. Follow hospital/regional policy (examiner qualifications, documentation, whether ancillary testing or repeat determination is required).
- Examination items (all must be absent)：Unresponsiveness/no induced movement, pupillary light reflex, corneal reflex, oculocephalic reflex (OCR), oculovestibular reflex (OVR), pharyngeal (gag) reflex, cough reflex (add sucking/rooting reflexes if < 6 months old)
- Positive apnea test：No spontaneous respiratory effort AND PaCO₂ ≥ 60 mmHg AND ↑ ≥ 20 mmHg over baseline (adults ≥ 1 time after the final examination)
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Brain Death / Death by Neurologic Criteria (DNC) Determination?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does Brain Death / Death by Neurologic Criteria (DNC) Determination upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.