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Confirmation of Death
Last updated 28th February 2022
Definition of Death
- The simultaneous and irreversible loss of consciousness, circulation and capacity to breathe.
- The following three common scenarios are recognised
Death by Sudden Cardiorespiratory Arrest
- Either because CPR has failed, is inappropriate or because treatment has been withdrawn
- The individual should be observed by the person responsible for confirming death for a minimum of 5 minutes to establish that irreversible cardiorespiratory arrest has occurred.
- The absence of mechanical cardiac function is normally confirmed by absence of central pulse on palpation and absence of heart sounds on auscultation, and can also be confirmed by asystole on a continuous ECG display if the patient happens to be monitored.
- Any spontaneous return of cardiac or respiratory activity during this period of observation should prompt a further 5 minutes observation.
- After 5 minutes of continued cardiorespiratory arrest the absence of pupillary responses to light, the absence of a corneal reflex and of any motor response to trapezius pinch or sternal rub should be confirmed. The time of death is recorded as the time at which these criteria are fulfilled.
Death as Expected with DNACPR in Place or Some Time Previously eg During Sleep
- Clear signs that are pathognomonic for death eg hypostasis, rigor mortis may already be present then
- If so then check for central pulse, heart beat, pupil reflexes and response to pain but no need to observe for further 5 minutes
- The time of death is recorded as the time at which these criteria are fulfilled.
Death Due to Irreversible Loss of Brain Stem Function
- This applies only to ITU patients who are comatose, apnoeic and ventilated but still have a heartbeat.
- Criteria required for determining brain stem death in these patients are the irreversible loss of brain stem reflexes, diagnosed by clinical neurological testing – click this link to Academy of Medical Royal Colleges Code of Practice for more detail
Necessary Documentation in Casesheet
- Cardio respiratory arrest confirmed for 5 minutes
- Pupils fixed and dilated
- No corneal reflex
- No response to trapezius pinch or sternal rub (note risk of bruising perimortem with supraorbital pressure)
- Time of death
- Signature, name, work contact number
- Phone GP if at all possible, particularly if sudden or traumatic death, or if relatives particularly distressed.
- Complete Death Confirmation Proforma and file in casenotes