Apnea Test for Brain Death Diagnosis in a Patient on Extracorporeal Membrane Oxygenation

Background: Apnea test in most countriesis a fundamental partin Brain Death (BD) diagnosis. In patients receiving extracorporeal membrane oxygenation supportpnea test remains challenging and controversial. Case: We report the case of a 40 yearold man receiving veno-venous Extracorporeal Membrane Oxygenation (ECMO) as a respiratory support presenting signs of brain death. Decreasing ECMO flow and gas sweep flow while the patients lungs were kept on a Continuous Positive Airway Pressure (CPAP) during the apnea test allowed the PaCO2 to increase without decreasing of PaO2. Discussion: In order to diagnose BD apnea test must be accomplished in some countries. Carbon dioxide removal by the ECMO membrane makes CO 2 rise verydifficult. Sweep gas decrease on ECMO can make CO 2 rise possible but exposes patients to hypoxemia. Decreasing gas flow on the oxygenator and concomitantly inflating the lungs on a 100% oxygen CPAP allowed us to perform apnea test safely. Conclusion: With the technique described apnea test can be safely assessed without exposing patients to hypoxemia.