The Undead Patient: The Complexity of Brain Death Determination in Drug Overdose

The Poison Lab

In this episode Ryan explores the concept of brain death and the implications of drug overdoses causing false positive diagnosis of brain death. He is joined by an author of the ACMT Position statement on brain death in overdose (Dr. Andrew Stolbach MD) as well as authors of two case reports (neuro critical care physician Dr. Ranier Reyes and emergency physician Dr. Doug Stranges) involving bupropion where patients had absent brain stem reflexes after overdose but made a full neurologic recovery. We delve into the criteria used to determine brain death and the challenges faced by families and healthcare professionals when dealing with this sensitive topic.

• 00:00-19:00 Introduction to brain death guidelines
• 19:00-28:00 Introduction to limitations in guidelines regarding overdose
• 28:30-38:00 Interview with ACMT Position statement author
• 39:00- End- Interview with Bupropion brain death mimic authors and summary

Links references in show

• American Academy of Neurology Bran death guidance
• ACMT Position statement on brain death in overdose
• Brain death mimics with cerebral edema
  • Case report of “hypoxic patient with diffuses cerebral edema” who recovered in 48 hour
  • Carbamazepine with diffuse cerebral edema who recovered
• Cases taking >2 months to recover brain stem reflexes
  • https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(02)07577-3/fulltext
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4543058/
• Attempts to withdraw care in as little as 48 hours
• Dr. Stranges case report
• Dr. Reyes case report
• Narrative review of brain death mimics
• Introductory cases
  • Caroline Burns- Patient who woke up on operating table
  • Paul Maturo- Patient woke up in a morgue