A Protocol that Mandates Postoxygenator and Arterial Blood Gases to Confirm Brain Death on Venoarterial Extracorporeal Membrane Oxygenation. Issue 2 (February 2020)

• Record Type: Journal Article
• Authors: Ihle, Joshua F.; Burrell, Aidan J. C.; Philpot, Steve J.; Pilcher, David V.; Murphy, Deirdre J.; Pellegrino, Vincent A.
• Is Part Of: ASAIO journal. Volume 66:Issue 2(2020)
• Publication Date: 2020-02
• Subjects: apnea test -- brain death -- ECMO; Artificial organs -- Periodicals; 617
• DOI: 10.1097/MAT.0000000000001086
• Languages: English
• ISSNs: 1058-2916

Abstract

Abstract : The apnea test (AT) during clinical brain death (BD) testing does not account for different arterial gas tensions on veno-arterial extracorporeal membrane oxygenation (V-A ECMO). We aimed to develop a protocol and now report our experience with three patients. The protocol was developed and implemented in 2015 at a quaternary center in Australia, measures both right radial and postoxygenator carbon dioxide (CO2 ) and oxygen (O2 ) gas tensions during the AT, incorporates regular gas sampling and a gradual reduction in fresh gas flow to ensure patient oxygenation. Patient 1 remained apneic despite both right radial and postoxygenator CO2 gas tensions >60 mmHg. Patient 2, despite having CO2 levels in a right radial arterial sample high enough to diagnose BD, postoxygenator CO2 remained <60 mmHg. Patient 2 did not breathe but radiological tests confirmed BD. Patient 3 showed respiratory effort but only once CO2 levels rose high enough in both right radial and postoxygenator samples. No patient was hypoxic during the AT. Performance of a reliable AT on V-A ECMO requires measurement of both right radial and postoxygenator blood gases. A protocol, which measures both blood gas values, is feasible to implement, while being both safe and easy to perform. Abstract : Supplemental Digital Content is available in the text.