Faculty Bibliography

Background/UNASSIGNED:We explored factors associated with admission and discharge code status after nontraumatic intracranial hemorrhage. Methods/UNASSIGNED:We extracted data from patients admitted to our institution between January 1, 2013, and March 1, 2016 with nontraumatic intracerebral hemorrhage or subarachnoid hemorrhage who had a discharge modified Rankin Scale (mRS) of 4 to 6. We reviewed data based on admission and discharge code status. Results/UNASSIGNED:.06). There was no significant difference between discharge code status and sex, age, marital status, premorbid mRS, discharge GCS, or bleed severity. Conclusions/UNASSIGNED:Limitation of code status after nontraumatic intracranial hemorrhage appears to be associated with older age, white race, worse APACHE II score, and active cancer. The role of palliative care after intracranial hemorrhage and the racial disparity in limitation and de-escalation of treatment deserves further exploration.

BACKGROUND AND PURPOSE/OBJECTIVE:We sought to 1) identify countries in Asia and the Pacific that have protocols for the determination of brain death/death by neurologic criteria (BD/DNC) and 2) review the similarities and differences of these protocols in different countries. METHODS:Between January 2018 and April 2019, we attempted to communicate with contacts in the 57 countries in Asia and the Pacific to determine if they had official national BD/DNC protocols. We reviewed and compared the identified protocols. RESULTS:We identified contacts for 40 (70%) of the 57 countries in Asia and the Pacific, and successfully communicated with 37 of them (93% of countries with contacts identified, 65% of countries in Asia and the Pacific). We found that 24 of the 37 countries had BD/DNC protocols. Two (13%) of the 16 protocols that provided a definition of death referred to brainstem death. Kazakhstan and Israel required only 1 examination to declare BD/DNC, while 10 (71%) of the other 14 protocols required 2 examinations separated by 6-48 hours. The prerequisites, clinical examination, apnea testing procedure, and indications for/selection of ancillary tests varied. Ancillary testing was required for all determinations of BD/DNC in five (21%) countries. Thirteen (54%) of the protocols included information about the time of death, while 12 (50%) of them provided instructions about discontinuation of organ support. CONCLUSIONS:The protocols for conducting a BD/DNC determination vary markedly among countries in Asia and the Pacific. Since it is optimal to have internationally and intranationally consistent BD/DNC protocols, efforts should be made to harmonize protocols both within this region and worldwide.

OBJECTIVES/OBJECTIVE:We sought to (1) identify the countries in the Latin America/Caribbean Group of the United Nations (GRULAC) that have protocols for brain death/death by neurologic criteria (BD/DNC) and (2) review the similarities and differences between these protocols. MATERIALS AND METHODS/METHODS:Between January 2018 and April 2019, we obtained and reviewed BD/DNC protocols from countries in GRULAC. RESULTS:We communicated with contacts in 30/33 countries in GRULAC (91 % of countries) and found that 16 (53 % of countries with contacts, 48 % of Latin American/Caribbean countries) had BD/DNC protocols. Of the 13 protocols that provided a definition of death, 10 (77 %) referred to whole brain death. The number of exams/examiners, prerequisites for BD/DNC, and descriptions of the clinical assessment and apnea test were inconsistent among protocols. Although Brazil and Panama required an ancillary test, the indications for ancillary testing, and the types of accepted ancillary tests, varied by country. CONCLUSION/CONCLUSIONS:BD/DNC determination protocols in the countries in GRULAC are inconsistent. Acknowledging the fact that there are diverse cultural, legal and religious perspectives on death, and human and technological resources differ by region, we recommend that attempts be made to harmonize protocols on BD/DNC both regionally and worldwide.