Case report
Determination of Brain Death by Apnea Test Adapted to Extracorporeal Cardiopulmonary Resuscitation

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Case 1

In April 2010, a 78-year-old man with a history of hypertension, hypercholesterolemia, and diabetes presented to the emergency department with worsening midsternal chest pain at rest. He underwent cardiac catheterization during which 2 stents were placed in the left anterior descending artery. Catheterization was complicated by coronary artery perforation, and the patient was transferred to the coronary care unit for further monitoring. Two days later, the patient again complained of chest pain

Discussion

Death is defined by the Uniform Determination of Death Act as “either (i) irreversible cessation of circulatory or respiratory functions, or (ii) irreversible cessation of all functions of the entire brain, including the brain stem …”6 The American Academy of Neurology offers a detailed brain death evaluation protocol.7 The clinical evaluation includes the documentation of a coma, the absence of brainstem reflexes, and apnea. The determination of a coma requires evidence of a lack of all

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Cited by (21)

  • The use of apnea test and brain death determination in patients on extracorporeal membrane oxygenation: A systematic review

    2021, Journal of Thoracic and Cardiovascular Surgery
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    There were 1 prospective case series, 1 retrospective cohort, 9 retrospective case series, and 11 case reports. The 22 included studies12-33 represented 177 patients in which BD was assessed while on ECMO. One patient was described in 2 studies29,33 and was counted only once.

  • Ethical Considerations for Mechanical Support

    2019, Anesthesiology Clinics
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    Even declaration of death by neurologic criteria (commonly referred to as “brain death”) has become more complicated with extracorporeal support, because certain traditional tests to determine irreversibility (ie, apnea test) are confounded by extracorporeal gas exchange. Ancillary tests to declare death by neurologic criteria may be required.43 These scenarios, in which ongoing physiologic functions preclude traditional determinations of cardiac death, may raise questions about the physician’s obligation to continue extracorporeal support in what may be viewed as potentially inappropriate care or even medical futility35—not necessarily physiologic futility given the potential to preserve end-organ function, but rather futility in supporting the life of a person as a whole.

  • Neurologic Complications of Extracorporeal Membrane Oxygenation: A Review

    2017, Journal of Cardiothoracic and Vascular Anesthesia
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    Additional methodologies that have been proposed for diagnosing brain death in ECMO patients include the use of a modified oxygenated apnea test. Continuous airways pressure is delivered while monitoring for respiratory activity.66,68 Other suggested alterations to the conventional apnea test have included the addition of exogenous carbon dioxide to the ECMO gas blender while monitoring for respiratory effort.69

  • Apnea testing on extracorporeal membrane oxygenation: Case report and literature review

    2015, Journal of Critical Care
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    Oxygen saturation can be monitored via pulse oximetry and via the inline monitoring of the ECMO circuit. Most reports, except those of Goswami et al [15] and Hoskote et al [17], provided supplemental O2 via the ETT after ventilator disconnection. In principle and for most patients, provided sweep rate is not turned off, adequate oxygen saturation should be able to be maintained with an FDO2 of 1.0 without further oxygen supplementation via the ETT.

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