The Challenges of Apnea Tests in the Determination of Brain Death in Child Patient on Extracorporeal Membrane Oxygenation

Frontiers in Pediatrics

article

Lingling Xu¹  Yujian Liang¹  Yuan Liao²  Jian Rong³  Guixing Xu²  Wen Tang¹ 

[1] Department of Pediatric Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University;Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University;Department of Extracorporeal Circulation, The First Affiliated Hospital, Sun Yat-sen University

关键词: apnea test;    brain death;    ECMO;    donation;    child;   

DOI  :  10.3389/fped.2020.00358

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Extracorporeal membrane oxygenation (ECMO) is a life-support modality used in patients with refractory cardiac and/or respiratory failure. ECMO is linked with high risk of neurological complications including brain death. Neurological monitoring during ECMO is important for identifying patients who are suspected of brain death and allows to discontinue ineffective medical treatments. Brain death (BD) is an irreversible cessation of functions of the entire brain, containing the brainstem. The apnea test (AT) is an essential part in the clinical determination of brain death. An apnea test is by neurologic criteria compulsory to confirm BD in China. Apnea test remains a problem for patients receiving ECMO. Currently, there are not any consensus guidelines for the safe performance of AT during ECMO. We report the case of a child on venous-arterial ECMO post-cardiac arrest in whom we performed an apnea test to determine death by neurologic criteria. Decreasing sweep gas flow rate 0.05 L/min every 5 min led to a PaCO 2 increase of more than 20 mmHg of apnea. The results of the AT was positive. When he was determined brain dead, his parents decided to donate his organs. AT can be performed on potential donor children on ECMO by decreasing the sweep gas flow. It is a safe and effective method and is important for BD determination.

【 授权许可】

CC BY