The Academy of Royal Medical Colleges(ARMC) code for the diagnosis and confirmation of death1 includes criteria for determining irreversible cessation of brain-stem function diagnosed by clinical neurological testing.
We report on the results of an audit conducted to assess what supplementary information clinicians provided when performing brain stem tests using the draft document provided in appendix 1 of the ARMC code of practice1.
Retrospective study of 30 sets of patient case notes in our tertiary referral Neurosurgical Intensive Care unit was performed for the year 2010 - 2011. Any documentation made supplementary to the ARMC document to support the diagnosis of brain stem death was recorded.
80% of records provided supplementary information to that on the form,. This was either as written text or printed arterial blood gas results.
The decision to proceed to organ donation is made on the basis of the neurological tests. This explains why clinicians feel it is incumbent on them to perform and document the tests rigorously.
On the basis of this audit, a new proforma has been introduced for the confirmation of brain stem death in our hospital. This includes documentation of: mean arterial pressure; body temperature; electrolytes; and arterial blood gas results during the apnoea testing.
This audit has therefore supported the introduction of a more comprehensive, ‘fit for purpose’ document for the determination of brain stem death in our institution. This is currently the subject of a repeat audit.
A Code of Practice for the Diagnosis and Confirmation of Death, Academy of Medical Royal Colleges, 2008 http://aomrc.org.uk/publications/reports-guidance.html (Accessed October 2011).
© 2012 European Society of Anaesthesiology