Letters

Discontinuation of ventilation after brain stem death

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7221.1366a (Published 20 November 1999) Cite this as: BMJ 1999;319:1366

Asystole rapidly follows brain stem death

  1. R Khanna, specialist registrar, accident and emergency department,
  2. M A Chaudhry, specialist registrar, accident and emergency department ([email protected])
  1. Walsall Manor Hospital, Walsall WS2 9PS
  2. Birmingham Heartlands Hospital, Birmingham B9 5SS
  3. Kupat Holim Clalit, Tel Aviv 62098, Israel

    EDITOR—We were interested in the educational debate concerning withdrawal of ventilatory support after confirmation of brain stem death.1 Clearly if ventilatory support is withdrawn without the agreement of the family, although such action may be medically and legally correct, the potential for sensationalised unfavourable headings in tabloid newspapers must be considered.

    Although the medicolegal and ethical aspects of the issue have been discussed, the scientific aspects have not been. Unlike in the persistent vegetative state, brain stem death is followed by a series of profound changes in the autonomic and hormonal mechanisms regulating the cardiovascular system. Complete cardiovascular and autonomic uncoupling has been shown in humans after brain stem death.2 …

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