Fig. 2.

Suggested algorithm for brain death screening after cardiac arrest. In a resuscitated patient who is unresponsive after rewarming from targeted temperature management (TTM), and after having excluded confounders, brain death is suspected if brainstem reflexes are all absent. Brain death can be suspected earlier if a catastrophic brain injury is demonstrated on CT or if the patient shows signs like fixed, dilated pupils, diabetes insipidus, or cardiovascular changes suggesting herniation. Brain death is confirmed by clinical observation and/or by confirmatory tests like apnoea, a flat EEG or absent cerebral blood flow, according to local legislation or protocols. Organ donation is considered after ascertainment of brain death. In cases where circulatory death occurs, either spontaneously or as a consequence of withdrawal of life-sustaining treatment (WLST), donation after circulatory death (DCD) can be considered. For the European Resuscitation Council and the European Society of Intensive Care Medicine (ERC–ESICM) recommended neuroprognostication protocol, see Ref. [55]