Apnea Testing During Brain Death Assessment: A Review of Clinical Practice and Published Literature

The diagnosis of brain death is a complex process. Strong knowledge of neurophysiology and an understanding of brain death etiology must be used to confidently determine brain death. The key findings in brain death are unresponsiveness, and absence of brainstem reflexes in the setting of a devastating neurological injury. These findings are coupled with a series of confirmatory tests, and the diagnosis of brain death is established based on consensus recommendations. The drive to breathe in the setting of an intense ventilatory stimulus (ie, respiratory acidosis) is a critical marker of brainstem function. As a consequence, apnea testing is an important component of brain death assessment. This procedure requires close monitoring of a patient as all ventilator support is temporarily removed and Paco2 levels are allowed to rise. A “positive” test is defined by a total absence of respiratory efforts under these conditions. While apnea testing is not new, it still lacks consensus standardization regarding the actual procedure, monitored parameters, and evidence-based safety measures that may be used to prevent complications. The purpose of this report is to provide an overview of apnea testing and discuss issues related to the administration and safety of the procedure.

Apnea test during brain death assessment in mechanically ventilated and ECMO patients

Table 1 from Problems associated with the apnea test in the diagnosis of brain death.

Apnea test during brain death assessment in mechanically ventilated and ECMO patients

PDF) Tension Pneumothorax During Apnea Testing for the Determination of Brain Death

Determination of Brain Death

Figure 4 from Apnea testing for the determination of brain death: a modified protocol. Technical note.

Potential Threats and Impediments to the Clinical Practice of Brain Death Determination

Brain Sciences, Free Full-Text

Brain Death/Death by Neurologic Criteria Determination

Critical synopsis and key questions in brain death determination

PDF) Apnea Testing During Brain Death Assessment: A Review of Clinical Practice and Published Literature

Apnea testing for the diagnosis of brain death - Lang - 2005 - Acta Neurologica Scandinavica - Wiley Online Library

The apnea test in brain death determination using oxygen diffusion method remains safe

The Physiology of the Apnea Test for Brain Death Determination in ECMO: Arguments for Blending Carbon Dioxide

Apnea Testing During Brain Death Assessment: A Review of Clinical Practice and Published Literature