Objective: To evaluate PICU patients with suspected brain death (BD) using current guideline of BD determination.

Methods: Taiwan has adopted a new guideline of BD determination since 2012, which included 3 necessary conditions: 1) irreversible coma, 2) absent brainstem reflexes, 3) apnea test ascertained. Accordingly, we conduct a retrospective study of BD patients admitted to the PICU in one medical center.

Results: During the study period, 19 non-traumatic comatose patients with various neurological diseases and suspected BD admitted to PICU were collected for analysis. There were 7 males and 12 females. The age ranged from 5 months to 14 years. The primary diseases were encephalitis of various types (3), ICH due to AVM rupture (3), brain tumor (3), septic shock (2), hypoxic ischemic encephalopathy (2), metabolic origin (2), adult RDS with DIC (1), near SIDS (1) and unknown cause (2). All fulfilled the criteria of deep coma. During the testing for brainstem functions, two patients, 5 month and 7 years old respectively, showed residual brainstem function and could not fulfill the criteria of brain death, turned out to be the victims of vegetative and survived later. The others expired in the following 2 months.

Conclusion: The current guideline for determination of brain death in children in Taiwan seems to be effective for the determination of BD, as that of United States and Canada. In addition to comatose prerequisite, meticulous brainstem function evaluation and apnea testing can help determining the status of brain death and predict the final outcomes.