title: A 10-month-old infant with reversible findings of brain death.
abstract: Death has occurred when there is irreversible loss of integration of the organism as a whole, and brain death is said to be a criterion for death. In the present case, a 10-month-old boy was found submerged in a bathtub and was given cardiopulmonary resuscitation for 37 minutes. He had received therapeutic dosing of phenobarbital and midazolam up to 5 hours prior to a brain death examination. He fulfilled all criteria for brain death according to Canadian Neurological Determination of Death Forum recommendations on an examination 42 hours after the drowning event, but started breathing another 15 hours later. Eleven previously published cases of purported reversal of findings of brain death are discussed here, including two infants who fulfilled all criteria for brain death for more than 24 hours. Recommendations for brain death determination may require revision for infants, to more clearly define a time interval between examinations and to incorporate consideration of confounding sedative drug effects. Together with previous reports, the present case calls into question the assumption that brain death as currently diagnosed is irreversible, and therefore equivalent to death of the patient.
authors.affiliation: Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada. ajoffe@cha.ab.ca
authors.forename: Ari R
authors.initials: AR
authors.lastname: Joffe
authors.forename: Hanna
authors.initials: H
authors.lastname: Kolski
authors.forename: Jonathan
authors.initials: J
authors.lastname: Duff
authors.forename: Allan R
authors.initials: AR
authors.lastname: deCaen
mesh_terms: D001921:Brain / Q000503:physiopathology; D001926:Brain Death / Q000175:diagnosis*; D004332:Drowning / Q000175:diagnosis / Q000503:physiopathology; D004569:Electroencephalography; D018691:Excitatory Amino Acid Antagonists / Q000627:therapeutic use; D018757:GABA Modulators / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D015701:Near Drowning / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D010634:Phenobarbital / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018691:Excitatory Amino Acid Antagonists; D018757:GABA Modulators; D008874:Midazolam; D010634:Phenobarbital