Incidence of Brainstem Dysfunction and Brain Death and End-of-Life Care Practices: A Two-Year Retrospective Review

Abstract

Objectives: Brainstem dysfunction and brain death are important determinants of End-of-life care (EoLC) decisions in intensive care units (ICUs). In many low- and middle-income settings, withdrawal or withholding of life-sustaining treatment remain ethically and culturally challenging despite high costs and limited critical-care resources. This study reviewed the incidence, causes and outcomes of brainstem dysfunction/brain death and examined relatives' decisions regarding EoL care (EoLC) in a tertiary hospital ICU. Materials and Methods: A retrospective chart review was conducted in the ICU of the University College Hospital, Ibadan, covering March 2020- February 2022. Data were extracted from ICU nurses' spreadsheets and patients' case notes and analysed using IBM Statistical Package for the Social Sciences software. Descriptive statistics were used to summarise demographic variables, causes of brainstem dysfunction, duration of survival after diagnosis and family decisions about EoLC. Results: Among 232 ICU deaths during the study period, 24 (10.3%) were preceded by brainstem dysfunction or death. Males constituted 75% of affected patients. The leading causes were severe head injury (54%) and haemorrhagic stroke (21%). About 58% of patients died within 24-72 h of diagnosis and 37.5% had cardiac arrest before brainstem death. Prognosis was discussed with relatives in only 37.5% of cases. The gag and pupillary reflexes were the most frequently used diagnostic tests (100%), while apnoea testing was performed in 12.5% of cases. Conclusion: Brainstem dysfunction accounted for about one-tenth of ICU deaths, predominantly following trauma and stroke. Limited family counselling and cultural reluctance toward EoL decisions remain major challenges. Strengthening communication, ethical awareness and policy support for EoLC could improve patient management and optimise utilisation of limited ICU resources.