naa a22 4500 510799639 CHVBK 20180411083349.0 cr unu---uuuuu 180411e20131001xx s 000 0 eng 10.1007/s12028-013-9845-y doi (NATIONALLICENCE)springer-10.1007/s12028-013-9845-y Apnea Test for Brain Death Determination in a Patient on Extracorporeal Membrane Oxygenation [Elektronische Daten] [Pierre Smilevitch, Laurent Lonjaret, Olivier Fourcade, Thomas Geeraerts] Background: Apnea test is a key component to confirm brain death. For patients receiving extracorporeal membrane oxygenation (ECMO), apnea test remains challenging. Brain death (BD) diagnosis is often made without apnea test. Case: We report the case of a 29-year-old man presenting clinical signs of BD while treated with ECMO therapy for refractory cardiogenic shock. Decreasing the ECMO sweep gas flow from 3 to 1L/min and increasing oxygen delivery to 100% on ECMO during the apnea test have allowed increasing the PaCO2 of more than 20mmHg without decreasing PaO2. Discussion: In order to diagnose BD, neurological examination should be complete, including apnea testing, which can be not possible in patients receiving ECMO due to CO2 removal from the membrane. Decreasing sweep gas rate allows reduction in CO2 diffusion through the membrane. However, decreasing the ECMO gas flow to zero could be insufficient to maintain normoxemia. Decreasing (but not stopping) the sweep gas flow to 1L/min and increasing the oxygen delivery through the ECMO have allowed performing the apnea test safely. Conclusion: To assess brain death in patients on ECMO, apnea test can be performed without compromising oxygenation by decreasing (but not stopping) the sweep gas flow and increasing oxygen delivery through the membrane. Springer Science+Business Media New York, 2013 Brain death nationallicence Extracorporeal membrane oxygenation nationallicence Apnea test nationallicence Sweep gas nationallicence Coma nationallicence Smilevitch Pierre Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Paul Sabatier, Toulouse, France aut Lonjaret Laurent Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Paul Sabatier, Toulouse, France aut Fourcade Olivier Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Paul Sabatier, Toulouse, France aut Geeraerts Thomas Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Paul Sabatier, Toulouse, France aut Neurocritical Care Springer US; http://www.springer-ny.com 19/2(2013-10-01), 215-217 1541-6933 19:2<215 2013 19 12028 https://doi.org/10.1007/s12028-013-9845-y text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12028-013-9845-y text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Smilevitch Pierre Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Paul Sabatier, Toulouse, France aut NATIONALLICENCE 700 1- Lonjaret Laurent Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Paul Sabatier, Toulouse, France aut NATIONALLICENCE 700 1- Fourcade Olivier Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Paul Sabatier, Toulouse, France aut NATIONALLICENCE 700 1- Geeraerts Thomas Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Paul Sabatier, Toulouse, France aut NATIONALLICENCE 773 0- Neurocritical Care Springer US; http://www.springer-ny.com 19/2(2013-10-01), 215-217 1541-6933 19:2<215 2013 19 12028 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer