Brief observation
Spontaneous and reflex movements in 107 patients with brain death

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Methods

We conducted a multicenter cohort study of patients with brain death admitted to the hospital care system of Buenos Aires from July 1997 to March 2003. All patients fulfilled standard criteria for brain death,2 including unresponsiveness or coma, absence of brainstem reflexes, and apnea. Whenever intensive care physicians made this diagnosis, the organ procurement team was called and brain death was confirmed by a trained and experienced neurologist. All patients had a second evaluation at the

Results

Among 107 patients with a confirmed diagnosis of brain death, 47 (44%) had spontaneous or reflex movements. The most common movements were the undulating toe reflex and the triple flexion response (Table 1). Twelve patients (26%) had more than one type of movement.

There were no statistically significant differences in age, sex, baseline temperature, blood pH, bicarbonate and partial pressure of carbon dioxide levels, and cause of death between patients with and without movements (Table 2).

Discussion

Anecdotal reports and retrospective case series have described involuntary, spontaneous, or reflex movements in as many as 75% of patients with brain death.6, 7, 11, 12, 13 However, many of these studies were performed before the current criteria for brain death were established. For example, one study8 used loss of the cough reflex to determine the time of brain death. In our study, we evaluated more than 100 patients over a 5-year period using a standardized protocol and found that almost

Acknowledgment

We are indebted to patients’ relatives who agreed with the video recording. We also appreciate the kind support of Dr. Jorge Deluca, the team of “Buenos Aires Transplant”, and emergency and intensive care physicians from the Community and University Hospitals of the City of Buenos Aires. We are also grateful to Drs. Fernando Rubinstein and Ezequiel García Elorrio, and members from the Clinical Effectiveness Program (PEC) at the University of Buenos Aires, for their collaboration with the study

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