Apnea test for the diagnosis of brain death in a patient undergoing extracorporeal membrane oxygenation

Abstract

Extracorporeal membrane oxygenation is used as extracirculatory support for the care of patients with severe and reversible cardiac and/or respiratory failure. Neurological complications may be related to the procedure. Given the unfavorable neurological evolution and the need to perform a brain death protocol, the performance of an apnea test in this context remains a challenge. We report the use of an apnea test for the diagnosis of brain death post-cardiac surgery in a patient receiving venoarterial extracorporeal membrane oxygenation.

Brain death post cardiac surgery: A modified apnea test to confirm death by neurologic criteria for a patient on extracorporeal membrane oxygenation

“…Various MATs have been proposed in an attempt to shorten the test and reduce complications 2 . Despite modifications, performing AT and determining DNC is more challenging in patients who are on ECMO 3,4 . The use of ECMO is increasing, including its use in extracorporeal cardiopulmonary resuscitation (ECPR) 5 .…”

“…Modified apnea tests (MATs) have been proposed in an attempt to reduce possible complications 2 . Despite modifications, performing an AT and determining DNC is more challenging in patients who are supported by extracorporeal membrane oxygenation (ECMO) 3,4 . Herein, we report the case of a patient on veno‐arterial (VA) ECMO for whom a MAT was conducted to confirm DNC.…”

“…CT, computer tomography F I G U R E 3 Technetium-99m ethyl cysteinate radionuclide brain perfusion scintigraphy demonstrating no cerebral perfusion performing AT and determining DNC is more challenging in patients who are on ECMO. 3,4 The use of ECMO is increasing, including its use in extracorporeal cardiopulmonary resuscitation (ECPR). 5 It has been reported that 21% of adults treated with ECPR progressed to DNC, 6 thus circumstances in which AT or MAT need to be performed on patients supported by ECMO are not infrequent.…”