Savaş ALTINSOY, İlkay Baran AKKUŞ, Sibel ÇATALCA, Fatma KAVAK AKELMA, Ceyda Özhan ÇAPARLAR, Jülide ERGİL

An approach to diagnosing brain death in patients undergoing extracorporeal membrane oxygenation

Objectives: This study was intended to discuss the process of brain death diagnosis of patients undergoing extracorporeal membrane oxygenation (ECMO) and our approach regarding the existing literature. Methods: Demographics data (age, gender, admission diagnosis) were noted. ECMO type applied (veno-venous or veno-arterial), time of diagnosing brain death (the time from admission time till diagnosis), being a donor or not, apnea testing application, supplementary tests applied at diagnosis stage (cerebral angiography, computerized tomography angiography, electroencephalography, transcranial doppler ultrasonography), and time of cardiac death (the time elapsing from the moment of brain death diagnosis till cardiac arrest) were noted. Results: Forty-two patients data were exaimed and ECMO was applied to 8 patients, 4 of whom are female and the others are male. The average age of the patients is 61.8 ± 9.8 years. The average time elapsing from the hospitalization till brain death diagnosis was 2.5 ± 0.5 days. Apart from that, only 2 (25%) of the patients were donors.Conclusions: The use of modified apnea testing on patients undergoing ECMO could be proliferated if such tests are standardized and reliable guidelines are set. For this reason, we think that cerebral angiography should be kept in mind in addition to apnea test especially on ECMO-treated patients.

Keywords:

Apnea test, apnea test, extracorporeal membrane oxygenation, cerebral angiography,

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1. Practice parameters for determining brain death in adults (summary statement). The Quality Standards Subcommittee of the American Academy of Neurology. Neurology 1995;45:1012-4.
2. Thery G, Rosman J, Julien G, Chaix F, Mateu P. Brain death: bilateral pneumothorax and pneumoperitoneum after an apnoea test. Anaesth Crit Care Pain Med 2019;38:89-90.
3. Sołek-Pastuszka J, Sawicki M, Iwańczuk W, Kojder K, Saucha W, Czajkowski Z, et al. Apnea testing using the oxygen insufflation method for diagnosis of brain death may compromise pulmonary function. J Crit Care 2018;44:175-8.
4. Xie A, Lo P, Yan TD, Forrest P. Neurologic complications of extracorporeal membrane oxygenation: a review. J Cardiothorac Vasc Anesth 2017;31:1836-46.
5. Giuseppe Citerio, MD, Paul G. Murphy, MD. Brain death: the European perspective. Semin Neurol 2015;35:139-44.
6. Saucha W, Solek-Pastuszka J, Bohatyrewicz R, Knapik P. Apnea test in the determination of brain death in patients treated with extracorporeal membrane oxygenation (ECMO). Anaesthesiol Intensive Ther 2015;47:368-71.
7. Smilevitch P, Lonjaret L, Fourcade O, Geeraerts T. Apnea test for brain death determination in a patient on extracorporeal membrane oxygenation. Neurocrit Care 2013;19:215-7.
8. Pirat A, Komurcu O, Yener G, Arslan G. Apnea testing for diagnosing brain death during extracorporeal membrane oxygenation. J Cardiothorac Vasc Anesth 2014;28:e8-9.
9. Muralidharan R, Mateen FJ, Shinohara RT, Schears GJ, Wijdicks EF. The challenges with brain death determination in adult patients on extracorporeal membrane oxygenation. Neurocrit Care 2011;14:423-6.
10. Hoskote SS, Fugate JE, Wijdicks EF. Performance of an apnea test for brain death determination in a patient receiving venoarterial extracorporeal membrane oxygenation. J Cardiothorac Vasc Anesth 2014;28:1027-9.
11. Smilevitch P, Lonjaret L, Fourcade O, Geeraerts T. Apnea test for brain death determination in a patient on extracorporeal membrane oxygenation. Neurocrit Care 2013;19:215-7.
12. Giani M, Scaravilli V, Colombo SM, Confalonieri A, Leo R, Maggioni E, et al. Apnea test during brain death assessment in mechanically ventilated and ECMO patients. Intens Care Med 2016;42:72-81.
13. Jouffroy R, Lamhaut L, Guyard A, Philippe AK, Spaulding C, Baud F, et al. Early detection of brain death using the Bispectral Index (BIS) in patients treated by extracorporeal cardiopulmonary resuscitation (E-CPR) for refractory cardiac arrest. Resuscitation 2017;120:8-13.
14. Bembea MM, Savage W, Strouse JJ, Schwartz JM, Graham E, Thompson CB, et al. Glial fibrillary acidic protein as a brain injury biomarker in children undergoing extracorporeal membrane oxygenation. Pediatr Crit Care Med 2011;12:572-9.
15. Kavi T, Esch M, Rinsky B, Rosengart A, Lahiri S, Lyden PD. Transcranial doppler changes in patients treated with extracorporeal membrane oxygenation. J Stroke Cerebrovasc Dis 2016;25:2882-5.
16. Spinello IM. Brain death determination. J Intensive Care Med. 2015;30:326-37.
17. Wijdicks EF. Brain death worldwide: accepted fact but no global consensus in diagnostic criteria. Neurology 2002;58:20-5.
18. Bronchard R, Durand L, Legeai C, Cohen J, Guerrini P, Bastien O. Brain-dead donors on extracorporeal membrane oxygenation. Crit Care Med 2017;45:1734-41.
19. Fan X, Chen Z, Nasralla D, Zeng X, Yang J, Ye S, et al. The organ preservation and enhancement of donation success ratio effect of extracorporeal membrane oxygenation in circulatory unstable brain death donor. Clin Transplant 2016;30:1306-13.
20. Lee H, Cho YH, Sung K, Yang JH, Chung CR, Jeon K, et al. The use of extracorporeal circulation in suspected brain dead organ donors with cardiopulmonary collapse. J Korean Med Sci 2015;30:1911-4.