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Brainstem death and prolonged disorders of consciousness 

Brainstem death and prolonged disorders of consciousness
Chapter:
Brainstem death and prolonged disorders of consciousness
Author(s):

Ari Ercole

, Peter J. Hutchinson

, and John D. Pickard

DOI:
10.1093/med/9780198746690.003.0580
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date: 27 February 2021

Advances in resuscitation and the advent of modern intensive care techniques to support the circulation challenge the simple definition of death in terms of loss of spontaneous circulation (‘cardiac death’). Instead, death is now better regarded as an irreversible loss of the capacity for consciousness combined with irreversible loss of the capacity to breathe. Since the brainstem is required for both consciousness and spontaneous breathing, irreversible loss of brainstem function (e.g. after trauma, haemorrhage, or hypoxia/ischaemia) defines the state of ‘brainstem death’. Clinical criteria for the diagnosis of brainstem death have been published, but practice varies around the world. Brainstem death lies at the extreme end of this spectrum and is, by definition, permanent. Unlike those with brainstem death, patients with prolonged disorders of consciousness may survive for many years without physiological support. The care of such patients has huge social, societal, ethical, and economic implications.

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