Challenges in Brain Death Determination and Apnea Testing for Patients with COVID-19

Radaideh, Yazan; Garg, Rajeev; Abdalla, Amina A.; Patel, Ankeet D; John, Sayona; Silva, Iván da

doi:10.1016/j.jstrokecerebrovasdis.2020.105419

Cited by 6 publications

(5 citation statements)

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“…During the prospective study period, there were 182 brain death evaluations, of which 138 involved apnea testing and 130 patients were declared dead after AT. The study period coincided with the recent coronavirus pandemic, during which apnea testing was, for a time, modi ed or in some cases, avoided out of concern for aerosolizing infectious particles [14][15][16]. Those apnea tests were excluded and did not have recruitment maneuvers performed.…”

Section: Resultsmentioning

confidence: 99%

A Recruitment Maneuver After Apnea Testing Improves Oxygenation and Reduces Atelectasis in Organ Donors After Brain Death

Dhar,

Braun,

Kumar

et al. 2024

Neurocrit Care

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Background and PurposeHypoxemia is the main modi able factor preventing lungs from being transplanted from organ donors after brain death (BD). One major contributor to impaired oxygenation in brain-injured patients is atelectasis. Apnea testing (AT), an integral component of BD declaration, promotes atelectasis and can worsen hypoxemia. In this study, we tested whether performing a recruitment maneuver (RM) after AT could mitigate hypoxemia and radiographic atelectasis. MethodsDuring the study period, an RM (PEEP of 15 cm H 2 O for 15 seconds then 30 cm H 2 O for 30 seconds) was performed immediately after AT. We measured PaO 2 before and after RM. The primary outcomes were oxygenation (PaO 2 :FiO 2 ratio, PFR) and the severity of atelectasis (proportion of lung without aeration on CT scans after BD, quanti ed using an image analysis algorithm) in those who became organ donors.Outcomes in RM cases were compared to controls undergoing AT without RM in the two years prior. ResultsRM was performed in 54 cases after AT, with a median immediate increase in PaO 2 of 63 mm Hg (IQR 0-109, p = 0.07). Eighteen RM resulted in hypotension but none were life-threatening. Of this cohort, 37 became organ donors, who were compared with 37 donors who had AT without RM. PFR was higher in the RM group (355 ± 129 vs. 288 ± 127, p = 0.03), and fewer had hypoxemia (PFR < 300: 22% vs. 57%, p = 0.04) at the start of donor management. The RM group showed less radiographic atelectasis (median 6% vs. 13%, p = 0.045). Although there was no difference in lungs transplanted (35% vs. 24%, p = 0.44), both better oxygenation and less atelectasis on arrival were associated with a higher likelihood of lungs being transplanted. ConclusionRM after AT results in immediate improvement in oxygenation and reduces hypoxemia and atelectasis in organ donors after BD. This effect may translate into more lungs being transplanted.

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Section: Resultsmentioning

confidence: 99%

A Recruitment Maneuver After Apnea Testing Improves Oxygenation and Reduces Atelectasis in Organ Donors After Brain Death

Dhar,

Braun,

Kumar

et al. 2024

Neurocrit Care

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“…There have also been new additions to the literature on apnea testing since publication of the WBDP. [114][115][116][117][118] A 2021 publication of a scoping review of publications on apnea testing from 1980 to 2019 provided additional knowledge about variability in apnea testing prior to publication of the WBDP. 114 The authors reported a variety of modifications, monitoring techniques, and complication rates and emphasized the need for updates to apnea testing protocols with the intent to strive for uniformity.…”

Section: New Publications Related To Apnea Testingmentioning

confidence: 99%

“…118 Finally, a few publications addressed the challenges of apnea testing in patients with COVID-19, which was nonexistent when the WBDP was written. [115][116][117]119,120 Beyond Minimum Clinical BD/DNC Determination…”

Section: New Publications Related To Apnea Testingmentioning

confidence: 99%

An Update on Brain Death/Death by Neurologic Criteria since the World Brain Death Project

Lewis

2024

Semin Neurol

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The World Brain Death Project (WBDP) is a 2020 international consensus statement that provides historical background and recommendations on brain death/death by neurologic criteria (BD/DNC) determination. It addresses 13 topics including: (1) worldwide variance in BD/DNC, (2) the science of BD/DNC, (3) the concept of BD/DNC, (4) minimum clinical criteria for BD/DNC determination, (5) beyond minimum clinical BD/DNC determination, (6) pediatric and neonatal BD/DNC determination, (7) BD/DNC determination in patients on ECMO, (8) BD/DNC determination after treatment with targeted temperature management, (9) BD/DNC documentation, (10) qualification for and education on BD/DNC determination, (11) somatic support after BD/DNC for organ donation and other special circumstances, (12) religion and BD/DNC: managing requests to forego a BD/DNC evaluation or continue somatic support after BD/DNC, and (13) BD/DNC and the law. This review summarizes the WBDP content on each of these topics and highlights relevant work published from 2020 to 2023, including both the 192 citing publications and other publications on BD/DNC. Finally, it reviews questions for future research related to BD/DNC and emphasizes the need for national efforts to ensure the minimum standards for BD/DNC determination described in the WBDP are included in national BD/DNC guidelines and due consideration is given to the recommendations about social and legal aspects of BD/DNC determination.

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“…Although there is no international consensus on the apnea test procedure, the most frequently chosen method is the "traditional apneic oxygenation" technique which requires the patient to be disconnected from the ventilator before observing spontaneous breathing. However, there is a high risk of aerosol formation in this method, in which the oxygen insufflation technique is used, and the risk can be reduced by clamping the endotracheal tube in this technique 5 . Aerosol generation and the risk of viral transmission during apnea test can also be reduced but not eliminated when continuous positive airway pressure delivered through a ventilator is used as a means of apneic oxygenation 6 During the pandemic process RT-PCR tests were required for every potential donor with a Glasgow Coma Scale score of 6 or lower, in line with the recommendations of the Scientific Advisory Board in our country, and it had been suggested to investigate travel and contact history and COVID-19 symptoms 11 .…”

Section: Introductionmentioning

confidence: 99%

Brain death diagnosis and management in the COVID-19 pandemic

Balkaya

Demirel

KORKMAZ

et al. 2022

Cukurova Medical Journal

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Purpose: This present study aimed to share experiences in the diagnosis and management of brain death (BD) and cadaveric donation cases, detected in a research hospital during the COVID-19 pandemic. Materials and Methods: BD cases diagnosed between 15/03/2020-15/05/2021 in our intensive care units (ICU) were retrospectively evaluated. Patients’ demographic characteristics, primary diagnoses, ICU admission time, and length of hospital stay were analyzed. Clinical suspicion, diagnosis, declaration, and donation or cardiac arrest times and supplementary tests to support the clinical judgment performed were also evaluated. Results: 37 cases, were included in the study. Intracranial hemorrhage was the most common (54.1%) diagnosis in ICU admissions. Apnea tests could be performed only in 27 patients (73%). Cerebral CT-angiography was used as a supplementarytary test in 27 (73%) cases. Family consent for organ donation was obtained from 10 patients (27%), and 70% (n= 7) of them became donors. The time between ICU admission and BD diagnosis time was 114±92.8 (11-360) hours, the time between clinical suspicion and diagnosis was 32±15.1 (4-78) hours, the time between diagnosis and cardiac arrest of non-donors was 24±15.2 (5-72) hours, and the time between diagnosis and donation was 23±7.6 (15-35) hours. Conclusion: Occupancy in ICUs due to COVID-19 has reduced the admission of patients who may be donors to ICUs, and there has been a decrease in the number of BD detection, family approval, and organ donation in our hospital.

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Challenges in Brain Death Determination and Apnea Testing for Patients with COVID-19

Cited by 6 publications

References 1 publication

A Recruitment Maneuver After Apnea Testing Improves Oxygenation and Reduces Atelectasis in Organ Donors After Brain Death

A Recruitment Maneuver After Apnea Testing Improves Oxygenation and Reduces Atelectasis in Organ Donors After Brain Death

An Update on Brain Death/Death by Neurologic Criteria since the World Brain Death Project

Brain death diagnosis and management in the COVID-19 pandemic

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