(129) Brain Death Education Across Intensivists

Introduction: Brain death (BD) determination occurs mostly in intensive care units (ICU). Prior studies have noted inconsistencies in BD determination across specialties, institutions, and states throughout the U.S. Whether differences in education and training are contributory factors has not previously been investigated. We aim to describe the current training landscape for BD testing amongst all critical care specialties.

Methods: A 12 question survey was created with an iterative process to gather information regarding level of practice, critical care specialty, method of BD training, and comfort in ordering ancillary tests and explaining the diagnosis. The survey was distributed through the Society of Critical Care Medicine eNews letter. A Welch t-test was used to determine if the difference in comfort performing BD testing was statistically significant.

Results: 364 intensivists finished the survey. Respondents were primarily practicing physicians (97.5%, n=355) representing critical care medicine (36%), surgery (19%), pulmonary (14.8%), cardiac (2.2%), anesthesia (6%), and neurocritical care (11.3%). Most respondents received formal BD training (83.8%). Only 36.4% of respondents were trained during fellowship. Formal training methods were defined as the use of a simulation lab (4.91%), during clinical practice only (35%), discussion only (22.7%), reading material only (17.4%), and discussion with visual aids (20.7%). Of the 16.2% (n=59) with no formal BD training, 84.7% (n=50) were independently performing BD exams in their current practice. Respondents without formal BD training were significantly less likely to report being “extremely comfortable” in performing the exam (47% vs 71%, p=.0027).

Conclusions: Less than half of respondents received formal BD training during fellowship, and many reported no formal training at any point in their career. Lack of formal training correlated with reduced comfort in performing BD exams. Of those who received formal training, the educational method is not standardized, with a significant number learning through clinical practice alone. Formal BD training during fellowship should be considered standard training for all critical care physicians.