open access

Vol 47, No 4 (2015)
Review articles
Submitted: 2015-09-20
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Apnea test in the determination of brain death in patients treated with extracorporeal membrane oxygenation (ECMO)

Wojciech Saucha, Joanna Sołek-Pastuszka, Romuald Bohatyrewicz, Piotr Knapik
DOI: 10.5603/AIT.2015.0051
·
Anaesthesiol Intensive Ther 2015;47(4):368-371.

open access

Vol 47, No 4 (2015)
Review articles
Submitted: 2015-09-20

Abstract

Extracorporeal Membrane Oxygenation (ECMO) is a well-established method of support in patients with severe respiratory and/or circulatory failure. Unfortunately, this invasive method of treatment is associated with a high risk of neurological complications including brain death. Proper diagnosis of brain death is crucial for the termination of futile medical care. Currently, the legal system in Poland does not provide an accepted protocol for apnea tests for patients on ECMO support. Veno-arterial ECMO is particularly problematic in this regard because it provides both gas exchange and circulatory support. CO2 elimination by ECMO prevents hypercapnia, which is required to perform an apnea test. Several authors have described a safe apnea test procedure in patients on ECMO. Maximal reduction of the sweep gas flow to the oxygenator should maintain an acceptable haemoglobin oxygenation level and reduce elimination of carbon dioxide. Hypercapnia achieved via this method should allow an apnea test to be conducted in the typical manner. In the case of profound desaturation and an inadequate increase in the arterial CO2 concentration, the sweep gas flow rate may be increased to obtain the desired oxygenation level, and exogenous carbon dioxide may be added to achieve a target carbon dioxide level. Incorporation of an apnea test for ECMO patients is planned in the next edition of the Polish guidelines on the determination of brain death.

Abstract

Extracorporeal Membrane Oxygenation (ECMO) is a well-established method of support in patients with severe respiratory and/or circulatory failure. Unfortunately, this invasive method of treatment is associated with a high risk of neurological complications including brain death. Proper diagnosis of brain death is crucial for the termination of futile medical care. Currently, the legal system in Poland does not provide an accepted protocol for apnea tests for patients on ECMO support. Veno-arterial ECMO is particularly problematic in this regard because it provides both gas exchange and circulatory support. CO2 elimination by ECMO prevents hypercapnia, which is required to perform an apnea test. Several authors have described a safe apnea test procedure in patients on ECMO. Maximal reduction of the sweep gas flow to the oxygenator should maintain an acceptable haemoglobin oxygenation level and reduce elimination of carbon dioxide. Hypercapnia achieved via this method should allow an apnea test to be conducted in the typical manner. In the case of profound desaturation and an inadequate increase in the arterial CO2 concentration, the sweep gas flow rate may be increased to obtain the desired oxygenation level, and exogenous carbon dioxide may be added to achieve a target carbon dioxide level. Incorporation of an apnea test for ECMO patients is planned in the next edition of the Polish guidelines on the determination of brain death.

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Keywords

brain death, diagnostics, apnea test; organ donor; extracorporeal circulation; ECMO

About this article
Title

Apnea test in the determination of brain death in patients treated with extracorporeal membrane oxygenation (ECMO)

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 47, No 4 (2015)

Pages

368-371

DOI

10.5603/AIT.2015.0051

Bibliographic record

Anaesthesiol Intensive Ther 2015;47(4):368-371.

Keywords

brain death
diagnostics
apnea test
organ donor
extracorporeal circulation
ECMO

Authors

Wojciech Saucha
Joanna Sołek-Pastuszka
Romuald Bohatyrewicz
Piotr Knapik

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