Drugs and brain death

Survey of Intensive Care Units and Availability of Drug Assays in Australasia

The availability of drug assays, toxicologic screens, or both can play a significant role in the clinical decision-making processes affecting comatose patients with brain injury, including the decision to continue life support. However, with the widespread trend to reduce such comprehensive laboratory services down to core routine drugs, many clinical staff are finding it increasingly difficult to obtain such assay results in a time-frame relevant to the clinical needs of their patients and families. The authors have surveyed the intensive care units in Australasia to assess their perspectives in this area. The results from 53% of units responding showed there was insufficient clinical pharmacologic support available. Whereas the majority of centers had ready access to the standard immunoassays and urine drug screens, few had access to more complex assays, especially in the time-frame that was required. Interestingly, there was wide variability between centers as to the time to terminate life support in the absence of other indices (e.g., 4-vessel angiography). The use of basic pharmacokinetic principles including drug half-life was practiced in some centers, albeit probably inappropriately in this patient subpopulation. There is generally insufficient availability of specialized drug assay laboratories to meet clinical demands, primarily because of reduction in services and financial constraints in the public hospital system.