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Special considerations in the assessment of catastrophic brain injury and determination of brain death in patients with SARS-CoV-2
INTRODUCTION: The coronavirus disease 2019 (Covid-19) pandemic has led to challenges in provision of care, clinical assessment and communication with families. The unique considerations associated with evaluation of catastrophic brain injury and death by neurologic criteria in patients with Covid-19...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier B.V.
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7414304/ https://www.ncbi.nlm.nih.gov/pubmed/32798855 http://dx.doi.org/10.1016/j.jns.2020.117087 |
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author | Valdes, Eduard Agarwal, Shashank Carroll, Elizabeth Kvernland, Alexandra Bondi, Steven Snyder, Thomas Kwon, Patrick Frontera, Jennifer Gurin, Lindsey Czeisler, Barry Lewis, Ariane |
author_facet | Valdes, Eduard Agarwal, Shashank Carroll, Elizabeth Kvernland, Alexandra Bondi, Steven Snyder, Thomas Kwon, Patrick Frontera, Jennifer Gurin, Lindsey Czeisler, Barry Lewis, Ariane |
author_sort | Valdes, Eduard |
collection | PubMed |
description | INTRODUCTION: The coronavirus disease 2019 (Covid-19) pandemic has led to challenges in provision of care, clinical assessment and communication with families. The unique considerations associated with evaluation of catastrophic brain injury and death by neurologic criteria in patients with Covid-19 infection have not been examined. METHODS: We describe the evaluation of six patients hospitalized at a health network in New York City in April 2020 who had Covid-19, were comatose and had absent brainstem reflexes. RESULTS: Four males and two females with a median age of 58.5 (IQR 47–68) were evaluated for catastrophic brain injury due to stroke and/or global anoxic injury at a median of 14 days (IQR 13–18) after admission for acute respiratory failure due to Covid-19. All patients had hypotension requiring vasopressors and had been treated with sedative/narcotic drips for ventilator dyssynchrony. Among these patients, 5 had received paralytics. Apnea testing was performed for 1 patient due to the decision to withdraw treatment (n = 2), concern for inability to tolerate testing (n = 2) and observation of spontaneous respirations (n = 1). The apnea test was aborted due to hypoxia and hypotension. After ancillary testing, death was declared in three patients based on neurologic criteria and in three patients based on cardiopulmonary criteria (after withdrawal of support (n = 2) or cardiopulmonary arrest (n = 1)). A family member was able to visit 5/6 patients prior to cardiopulmonary arrest/discontinuation of organ support. CONCLUSION: It is feasible to evaluate patients with catastrophic brain injury and declare brain death despite the Covid-19 pandemic, but this requires unique considerations. |
format | Online Article Text |
id | pubmed-7414304 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Elsevier B.V. |
record_format | MEDLINE/PubMed |
spelling | pubmed-74143042020-08-10 Special considerations in the assessment of catastrophic brain injury and determination of brain death in patients with SARS-CoV-2 Valdes, Eduard Agarwal, Shashank Carroll, Elizabeth Kvernland, Alexandra Bondi, Steven Snyder, Thomas Kwon, Patrick Frontera, Jennifer Gurin, Lindsey Czeisler, Barry Lewis, Ariane J Neurol Sci Clinical Short Communication INTRODUCTION: The coronavirus disease 2019 (Covid-19) pandemic has led to challenges in provision of care, clinical assessment and communication with families. The unique considerations associated with evaluation of catastrophic brain injury and death by neurologic criteria in patients with Covid-19 infection have not been examined. METHODS: We describe the evaluation of six patients hospitalized at a health network in New York City in April 2020 who had Covid-19, were comatose and had absent brainstem reflexes. RESULTS: Four males and two females with a median age of 58.5 (IQR 47–68) were evaluated for catastrophic brain injury due to stroke and/or global anoxic injury at a median of 14 days (IQR 13–18) after admission for acute respiratory failure due to Covid-19. All patients had hypotension requiring vasopressors and had been treated with sedative/narcotic drips for ventilator dyssynchrony. Among these patients, 5 had received paralytics. Apnea testing was performed for 1 patient due to the decision to withdraw treatment (n = 2), concern for inability to tolerate testing (n = 2) and observation of spontaneous respirations (n = 1). The apnea test was aborted due to hypoxia and hypotension. After ancillary testing, death was declared in three patients based on neurologic criteria and in three patients based on cardiopulmonary criteria (after withdrawal of support (n = 2) or cardiopulmonary arrest (n = 1)). A family member was able to visit 5/6 patients prior to cardiopulmonary arrest/discontinuation of organ support. CONCLUSION: It is feasible to evaluate patients with catastrophic brain injury and declare brain death despite the Covid-19 pandemic, but this requires unique considerations. Elsevier B.V. 2020-10-15 2020-08-08 /pmc/articles/PMC7414304/ /pubmed/32798855 http://dx.doi.org/10.1016/j.jns.2020.117087 Text en © 2020 Elsevier B.V. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Clinical Short Communication Valdes, Eduard Agarwal, Shashank Carroll, Elizabeth Kvernland, Alexandra Bondi, Steven Snyder, Thomas Kwon, Patrick Frontera, Jennifer Gurin, Lindsey Czeisler, Barry Lewis, Ariane Special considerations in the assessment of catastrophic brain injury and determination of brain death in patients with SARS-CoV-2 |
title | Special considerations in the assessment of catastrophic brain injury and determination of brain death in patients with SARS-CoV-2 |
title_full | Special considerations in the assessment of catastrophic brain injury and determination of brain death in patients with SARS-CoV-2 |
title_fullStr | Special considerations in the assessment of catastrophic brain injury and determination of brain death in patients with SARS-CoV-2 |
title_full_unstemmed | Special considerations in the assessment of catastrophic brain injury and determination of brain death in patients with SARS-CoV-2 |
title_short | Special considerations in the assessment of catastrophic brain injury and determination of brain death in patients with SARS-CoV-2 |
title_sort | special considerations in the assessment of catastrophic brain injury and determination of brain death in patients with sars-cov-2 |
topic | Clinical Short Communication |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7414304/ https://www.ncbi.nlm.nih.gov/pubmed/32798855 http://dx.doi.org/10.1016/j.jns.2020.117087 |
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