J Korean Soc Transplant.  2017 Mar;31(1):49-51. 10.4285/jkstn.2017.31.1.49.

Reduction of Apnea Test Time in an Extracorporeal Membrane Oxygenation-Dependent Potential Donor

• Jee HS
• Cha S
• Kim GS

• KMID: 2375680
• DOI: http://doi.org/10.4285/jkstn.2017.31.1.49

Abstract

The diagnosis of brain death is essential for deceased donor organ transplantation. Currently, extracorporeal membrane oxygenation (ECMO) is used to increase the chance of survival of patients with severe cardiac and respiratory failure. Therefore, cases of ECMO-dependent potential donors are increasing. The apnea test (AT) is a mandatory component in the clinical determination of brain death. However, conventional AT is not easily applicable to ECMO-dependent potential donors because both the ventilator and ECMO play an important role in carbon dioxide elimination. Accordingly, different methods of AT from those used in routine procedures must be considered. We report here a case of conventional AT with time delay and two cases of AT within 3 minutes by adjusting sweep gas flow rate of ECMO in ECMO-dependent potential donors.

Keyword

Apnea test; Brain death; Extracorporeal membrane oxygenation

MeSH Terms

Apnea*
Brain Death
Carbon Dioxide
Diagnosis
Extracorporeal Membrane Oxygenation
Humans
Membranes*
Organ Transplantation
Respiratory Insufficiency
Tissue Donors*
Transplants
Ventilators, Mechanical
Carbon Dioxide

Reference

1). Scott JB., Gentile MA., Bennett SN., Couture M., MacIntyre NR. Apnea testing during brain death assessment: a review of clinical practice and published literature. Respir Care. 2013. 58:532–8.

2). Lang CJ., Heckmann JG. Apnea testing for the diagnosis of brain death. Acta Neurol Scand. 2005. 112:358–69.

3). Lovrencic-Huzjan A. Transcranial Doppler as an confirmatory test in brain death. Randhawa G, editor. Organ donation and transplantation: public policy and clinical perspectives. Rijeka: Intech;2012. 267-84. Available from:. http://www.intechopen.com/books/organ-donation-and-transplantationpublic-policy-and-clinical-perspectives/transcranial-doppler-as-an-confirmatory-test-in-brain-death.

4). Gattinoni L., Carlesso E., Langer T. Clinical review: extracorporeal membrane oxygenation. Crit Care. 2011. 15:243.

5). Chung M., Shiloh AL., Carlese A. Monitoring of the adult patient on venoarterial extracorporeal membrane oxygenation. ScientificWorldJournal. 2014. 2014:393258.

6). Kim EY., Kim JH. Predisposing hemodynamic factors associated with a failed apnea test during brain death determination. Korean J Crit Care Med. 2016. 31:236–42.