• Michaël Chassé, Joel Neves Briard, Michael Yu, P CarvalhoLiviaLCentre de recherche du Centre hospitalier de l'Université de Montréal, 900 rue St-Denis, Montreal, QC, H2X 3H8, Canada., W EnglishShaneSCritical Care, University of Ottawa, Ottawa, ON, Canada.Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada., Frédérick D'Aragon, François Lauzier, F TurgeonAlexisACHU de Québec Research Center, Université Laval, Quebec City, QC, Canada.Critical Care, Université Laval, Quebec City, QC, Canada., Sonny Dhanani, Lauralyn McIntyre, D ShemieSamSDonation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada.Critical Care, Montreal Children's Hospital, Montreal, QC, Canada.McGill University Health Centre and Research Institute, Montreal, QC, Canada., Gregory Knoll, Dean A Fergusson, Samantha J Anthony, Matthew J Weiss, and Canadian Critical Care Trials Group.
• Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 rue St-Denis, Montreal, QC, H2X 3H8, Canada. michael.chasse@umontreal.ca.
• Can J Anaesth. 2022 Mar 1; 69 (3): 353363353-363.

PurposeTrust in the deceased organ donation process relies on the expectation that the diagnosis of death by neurologic criteria (DNC) is accurate and reliable. The objective of this study was to assess the perceptions and approaches to DNC diagnosis among Canadian intensivists.MethodsWe conducted a self-administered, online, cross-sectional survey of Canadian intensivists. Our sampling frame included all intensivists practicing in Canadian institutions. Results are reported using descriptive statistics.ResultsAmong 550 identified intensivists, 249 (45%) completed the survey. Respondents indicated they would be comfortable diagnosing DNC based on clinical criteria alone in cases where there is movement in response to stimulation (119/248; 48%); inability to evaluate upper/lower extremity responses (84/249; 34%); spontaneous peripheral movement (76/249; 31%); inability to evaluate both oculocephalic and oculo-caloric reflexes (40/249; 16%); presence of high cervical spinal cord injury (40/249; 16%); and within 24 hr of hypoxemic-ischemic brain injury (38/247; 15%). Most respondents agreed that an ancillary test should always be conducted when a complete clinical evaluation is impossible (225/241; 93%); when there is possibility of a residual sedative effect (216/242; 89%); when the mechanism for brain injury is unclear (172/241; 71%); and if isolated brainstem injury is suspected (142/242; 59%). Sixty-six percent (158/241) believed that ancillary tests are sensitive and 55% (132/241) that they are specific for DNC. Respondents considered the following ancillary tests useful for DNC: four-vessel conventional angiography (211/241; 88%), nuclear imaging (179/240; 75%), computed tomography (CT) angiography (156/240; 65%), and CT perfusion (134/240; 56%).ConclusionThere is variability in perceptions and approaches to DNC diagnosis among Canadian intensivists, and some practices are inconsistent with national recommendations.© 2021. Canadian Anesthesiologists' Society.

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