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Abstract
Background: Persistent cessation of all cerebral and
brainstem function (brain death) is accepted in most Introduction
countries as legal evidence of death. It is presumed that
cardiac function will cease within a short time after brain In most western countries, the concept of brain death is
death has occurred. In some countries, such as Kuwait, well accepted. When a diagnosis of brain death has been
tradition and practice discourage application of the brain made, respirator and other supportive measures are dis-
death criteria despite legal acceptance. Objective: The continued, and the heart usually stops beating within
study was designed to assess the duration of persistence hours to days [1–4]. It has been presumed that, even with
of cardiac function in patients after the diagnosis of brain artificial cardiorespiratory support, spontaneous cessa-
death had been made on the basis of generally accepted tion of cardiac function soon supervenes. Indeed, it is
criteria. Methods: We evaluated how long cardiac func- stated in a leading book on coma that cardiac function is
tion persisted after brain function had ceased in 40 seldom maintained more than 48 h after brain death has
patients in Kuwait who were admitted to hospital and occurred despite full mechanical support [5]. While this
died during the 10-year period 1992–2001. Results: It was belief is generally accepted, this area still remains contro-
found that the mean persistence of cardiac function after versial, and at least one meta-analysis of published reports
brain death was 8.20 days and the median survival time showed that there are some cases in which asystole did not
was 6 days. Two thirds of the patients survived longer occur for months or even years [6]. In a retrospective
than a week, but none had cardiac function for longer study in Taiwan, cardiac death occurred within 7 days in
than 30 days. Conclusion: The study confirms that brain 97% of 73 patients in whom brainstem death was diag-
death is not automatically followed immediately by ces- nosed [7].
References
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