Definition of brainstem death

• A person is dead when they have irreversibly lost the capacity for
consciousness and breathing.
• In these patients, death is diagnosed after confirming simultaneous
onset of apnoea and unconsciousness, the absence of circulation for a
minimum of 5 min (central pulse on palpation and heart sounds on
auscultation) and the absence of neurological reflexes (pupillary
responses, corneal reflex and motor response to supraorbital
pressure).
• Brainstem testing involves three distinct stages: identifying the cause
and excluding potentially reversible causes, testing brainstem reflexes
and apnoea testing.
Mengidentifikasi penyebab

• Before brainstem testing, it is absolutely crucial to observe

preconditions, in particular to establish the cause of the brain injury
and to exclude potentially reversible Causes. In the absence of a clear
cause, it is wise to have a period of watchful waiting.
Brainstem testing

On meeting the preconditions above, the following brainstem reflexes

should be tested:
• pupillary reactions (fixed and dilated)
• corneal reflex (absent)
• pharyngeal and tracheal gag reflex using tongue depressoror suction
catheter (absent)
• pain response by applying pressure to temporomandibular joint or
supraorbital ridges (absent) and
• vestibular–ocular reflexes using caloric testing (absent).
Tes Apnea

• Testing the response to hypercarbia is performed last, mainly because

it is most difficult and most likely to cause problems. The aim is to
raise the arterial CO2 before disconnecting the ventilator to assess
respiratory function. In a patient with normally functioning brainstem,
hypercarbia and subsequent metabolic acidosis should stimulate
increased respiration by stimulating the medullary respiratory
centres. Loss of respiratory drive implies severe brainstem damage
and loss of capacity for independent breathing.